JP7120984B2 - Aerosol pirfenidone and pyridone analog compounds and uses thereof - Google Patents

Description

(Priority claim)
This application is subject to U.S. Provisional Patent Application No. 61/675,286, entitled "AEROSOL PIRFENIDONE AND PYRIDONE ANALOG COMPOUNDS AND USES THEREOF," filed July 24, 2012; U.S. Provisional Patent Application No. 61/756,983 entitled "AEROSOL PIRFENIDONE AND PYRIDONE ANALOG COMPOUNDS AND USES THEREOF," filed May 17, 2013, entitled "AEROSOL PIRFENIDONE AND PYRIDONE ANALOG COMPOUNDS AND USES THEREOF." No. 61/824,818 is claimed, all of which are hereby incorporated by reference in their entireties.

The present invention, in its multiple embodiments, provides pirfenidone-like drugs to the desired anatomical site for the treatment and/or prevention of various pulmonary, neurological, cardiovascular, solid organ disease conditions. liquid, dry powder and metered dose formulations for therapeutic inhalation delivery of pyridone compositions.

Many undesirable pulmonary diseases such as interstitial lung disease (ILD and its subclasses), chronic obstructive pulmonary disease (COPD and its subclasses), asthma and kidney, heart and Symptoms of ocular fibrosis are initiated by external stress. By non-limiting examples, these effectors can include infection, smoking, environmental exposure, radiation exposure, surgical procedures, and transplant rejection. However, it can also be attributed to other causes related to genetics and the effects of aging. Described herein are compositions of pirfenidone or pyridone analog compounds suitable for inhaled delivery to the lung and/or systemic compartments, and methods of using such compositions.

According to certain embodiments of the present invention, pirfenidone for the prevention or treatment of various fibrotic and inflammatory diseases, including diseases associated with the lungs, heart, kidneys, liver, eyes, and central nervous system. Pirfenidone or pyridone analog compound formulations for delivery by buccal, pulmonary, or intranasal inhalation are provided, including formulations for aerosol administration of the pyridone analog compound.

In one aspect, described herein is a method of treating pulmonary disease in a mammal, comprising pirfenidone or a pyridone analog by inhalation into a mammal in need thereof on a continuous dosing schedule. administering a dose of the compound. In some embodiments, the continuous dosing schedule is daily, every other day, every 3 days, every 4 days, every 5 days, every 6 days, every week, every other week, every month, or every other month of pirfenidone or pyridone. A step of administering a dose of the analog compound is included. In some embodiments, the daily or less-than-daily dosing schedule comprises administering 1, 2, or more than 3 doses of the pirfenidone or pyridone analog compound. In some embodiments, each inhaled dose of the pirfenidone or pyridone analog compound is administered in a nebulizer, a metered dose inhaler, or a dry powder inhaler. In some embodiments, each inhaled dose comprises an aqueous solution of the pirfenidone or pyridone analog compound. In some embodiments, each inhaled dose comprises from about 0.1 mL to about 6 mL of an aqueous solution of the pirfenidone or pyridone analog compound, wherein the concentration of the pirfenidone or pyridone analog compound in the aqueous solution is is about 0.1 mg/mL to about 60 mg/mL, and the osmolality of aqueous solutions is about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, each inhaled dose aqueous solution is further selected from co-solvents, tonicity agents, sweeteners, surfactants, wetting agents, chelating agents, antioxidants, salts, and buffers. containing one or more additional ingredients that In some embodiments, the aqueous solution of each inhaled dose is from citrate or phosphate buffer and sodium chloride, magnesium chloride, sodium bromide, magnesium bromide, calcium chloride, and calcium bromide. Further comprising one or more salts selected from the group consisting of: In some embodiments, each inhaled dose of an aqueous solution comprises water; a pirfenidone or pyridone analog compound at a concentration of about 0.1 mg/mL to about 20 mg/mL; one or more salts (wherein 1 and optionally phosphoric acid to maintain the pH of the solution at about pH 5.0 to about pH 8.0. a buffer, or a citrate buffer that maintains the pH of the solution from about 4.0 to about 7.0; and the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, each inhaled dose is administered with a liquid nebulizer. In some embodiments, the liquid nebulizer (i) achieves pulmonary deposition of at least 7% of the pirfenidone or pyridone analog compound administered to the mammal after administration of an inhaled dose; (ii) about Resulting in a Geometric Standard Deviation (GSD) of the emitted droplet diameter distribution of aqueous solutions from 1.0 μm to about 2.5 μm; (iii) a) high performance liquids from about 1 μm to about 5 μm; b) a volumetric mean diameter (VMD) of from about 1 μm to about 5 μm; and/or c) about 1 μm. (iv) a fine particle fraction (FPF=%≦5 μm) of droplets emitted from a liquid sprayer of at least about 30%; (v) at least and/or (vi) providing at least about 25% of the aqueous solution to the mammal. In some embodiments, a) the lung tissue Cmax of the pirfenidone or pyridone analog compound from each inhaled dose is at least as high as the lung tissue Cmax of the pirfenidone or pyridone analog compound oral dose of up to 801 mg; and/or b) the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose administered directly to the lungs of a mammal is equal to or greater than that of pirfenidone or pyridone Blood AUC _0-24 less than or equal to an oral dose of 801 mg of the analog compound. In some embodiments, the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose is less than the blood AUC _0-24 of the pirfenidone or pyridone analog compound oral dose of up to 801 mg. is less than In some embodiments, the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose is less than the blood AUC _0-24 of the pirfenidone or pyridone analog compound oral dose of up to 801 mg. less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, less than 2.5%, less than 1.0%, 0 less than .5%, less than 0.25%, less than 0.1%, less than 0.05%, less than 0.025%, or less than 0.01%. In some embodiments, the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose is less than the blood AUC _0-24 of the pirfenidone or pyridone analog compound oral dose of up to 801 mg. between 0.01-90% of the %, 0.01-20%, 0.01-10%, 0.01-5%, 0.01-2.5%, 0.01-1%, 0.01-0.1%, 5- Between 90%, Between 5-80%, Between 5-70%, Between 5-60%, Between 5-50%, Between 5-40%, Between 5-30%, 5-20 between %, between 5-10%, between 1-5%, between 1-10%, between 1-20%, between 1-30%, between 1-40%, 1-50% between 1-60%, between 1-70%, between 1-80%, or between 1-90%. In some embodiments, each inhaled dose is less than half the oral dose of the pirfenidone or pyridone analog compound, up to 801 mg. In some embodiments, each inhaled dose is 1/2, 1/3, 1/4, 1/5, 1/6, up to 801 mg of the oral dose of pirfenidone or pyridone analog compound. 1/8, 1/10, 1/20, 1/40, 1/50, 1/75, 1/100, 1/200, or less than 1/400. In some embodiments, the pirfenidone or pyridone analog compound is administered at least once a week. In some embodiments, the pirfenidone or pyridone analog compound is administered on a continuous daily dosing schedule. In some embodiments, the pirfenidone or pyridone analog compound is administered once daily, twice daily, or three times daily. In some embodiments, the pulmonary disease is idiopathic pulmonary fibrosis, lung cancer, or pulmonary hypertension. In some embodiments, the lung disease is idiopathic pulmonary fibrosis. In some embodiments, the lung disease is pulmonary hypertension. In some embodiments, the lung disease is pulmonary hypertension secondary to interstitial lung disease. In some embodiments, the lung disease is cancer. In some embodiments, the lung disease is lung cancer. In some embodiments, the lung disease is lung cancer where the therapeutic target is the tumor stroma. In some embodiments, the lung disease is lung cancer and treating comprises inhibiting, reducing, or slowing the growth of lung tumor stroma. In some embodiments, the method further comprises administering to the mammal one or more additional therapeutic agents.

In another aspect, described herein is a method of treating pulmonary disease in a mammal comprising: administering a dose of a pirfenidone or pyridone analog compound by inhalation to a mammal in need thereof. wherein the blood AUC _0-24 of the pirfenidone or pyridone analog compound from an inhaled dose is less than the blood AUC _0-24 of an oral dose of pirfenidone or pyridone analog compound up to 801 mg. In some embodiments, the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose is less than the blood AUC _0-24 of the pirfenidone or pyridone analog compound oral dose of up to 801 mg. less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, less than 2.5%, less than 1.0%, 0 less than 0.5%, less than 0.25%, less than 0.1%, less than 0.05%, less than 0.025%, or less than 0.01%. In some embodiments, the blood AUC _0-24 of the pirfenidone or pyridone analog compound from each inhaled dose is less than the blood AUC _0-24 of the pirfenidone or pyridone analog compound oral dose of up to 801 mg. between 0.01-90% of the %, 0.01-20%, 0.01-10%, 0.01-5%, 0.01-2.5%, 0.01-1%, 0.01-0.1%, 5- Between 90%, Between 5-80%, Between 5-70%, Between 5-60%, Between 5-50%, Between 5-40%, Between 5-30%, 5-20 between %, between 5-10%, between 1-5%, between 1-10%, between 1-20%, between 1-30%, between 1-40%, 1-50% between 1-60%, between 1-70%, between 1-80%, or between 1-90%. In some embodiments, the inhaled dose of the pirfenidone or pyridone analog compound is administered in a nebulizer, a metered dose inhaler, or a dry powder inhaler. In some embodiments, the inhaled dose comprises an aqueous solution of the pirfenidone or pyridone analog compound, and the dose is administered in a liquid nebulizer. In some embodiments, each inhaled dose administered directly to the lungs of a mammal comprises from about 0.1 mL to about 6 mL of an aqueous solution of the pirfenidone or pyridone analog compound, wherein The concentration of the pirfenidone or pyridone analog compound of is about 0.1 mg/mL to about 60 mg/mL, and the osmolality of the aqueous solution is about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, each inhaled dose aqueous solution is further selected from; co-solvents, tonicity agents, sweeteners, surfactants, wetting agents, chelating agents, antioxidants, salts, and buffers. containing one or more additional ingredients that In some embodiments, each inhaled dose of an aqueous solution further includes; citrate buffer or phosphate buffer, and sodium chloride, magnesium chloride, sodium bromide, magnesium bromide, calcium chloride, and calcium bromide one or more salts selected from the group consisting of In some embodiments, each inhaled dose of an aqueous solution comprises; water; a pirfenidone or pyridone analog compound at a concentration of about 0.1 mg/mL to about 20 mg/mL; and optionally phosphoric acid to maintain the pH of the solution at about pH 5.0 to about pH 8.0. a buffer, or a citrate buffer that maintains the pH of the solution from about 4.0 to about 7.0. In some embodiments, the inhaled dose of the pirfenidone or pyridone analog compound is administered on a continuous dosing schedule. In some embodiments, the pulmonary disease is idiopathic pulmonary fibrosis, lung cancer, or pulmonary hypertension. In some embodiments, the lung disease is idiopathic pulmonary fibrosis. In some embodiments, the lung disease is pulmonary hypertension. In some embodiments, the lung disease is pulmonary hypertension secondary to interstitial lung disease. In some embodiments, the lung disease is cancer. In some embodiments, the lung disease is lung cancer. In some embodiments, the lung disease is lung cancer where the therapeutic target is the tumor stroma. In some embodiments, the lung disease is lung cancer and treating comprises inhibiting, reducing, or slowing the growth of lung tumor stroma. In some embodiments, the method further comprises administering to the mammal one or more additional therapeutic agents.

In one aspect, described herein is an aqueous solution for nebulized inhalation administration, wherein the aqueous solution is: water; a pirfenidone or pyridone analog compound at a concentration of about 0.1 mg/mL to about 20 mg/mL. wherein the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, the aqueous solution does not contain any co-solvents and/or surfactants. In some embodiments, the solution further comprises one or more additional ingredients selected from buffers and salts. In some embodiments, the buffer is a citrate buffer or phosphate buffer; and the salt is sodium or magnesium chloride, or sodium or magnesium bromide, calcium chloride or calcium bromide. pirfenidone or pyridone analog compound at a concentration of about 1 mg/mL to about 20 mg/mL; wherein the total amount of one or more salts is about 0.01% to about 2 .0% v/v; and optionally a phosphate buffer that maintains the pH of the solution from about pH 6.0 to about pH 8.0, or maintains the pH of the solution from about 4.0 to about 7.0. citrate buffer. pirfenidone or pyridone analog compound at a concentration of about 5 mg/mL to about 18 mg/mL; wherein the total amount of one or more salts is about 0.01% to about 2 .0% v/v; and optionally a phosphate buffer that maintains the pH of the solution from about pH 6.0 to about pH 8.0, or maintains the pH of the solution from about 4.0 to about 7.0. citrate buffer; wherein the aqueous solution has an osmolality of from about 50 mOsmol/kg to about 2000 mOsmol/kg.

In embodiments described herein, inhaled doses are delivered <5, <4, <3, <2, <1 times per day, or less than daily. In some embodiments, the inhaled dose is delivered by nebulization using standard Cheyne-Stokes tidal breathing of a continuous-flow aerosol, or a breath-triggering aerosol. In such embodiments of nebulization delivery, delivery times may be <20, <15, <10, <8, <6, <4, <2, and <1 minutes. In some embodiments, the inhaled dose is <10, <8, <6, <5, <4, either passive dispersive dry powder inhaler or active dispersive dry powder inhaler. Delivered by inhalation of a dispersed dry powder aerosol using <3, <2, or 1 breaths. In some embodiments, the inhaled dose is <10, <8, <6, <5, <4, <3, <2, or 1 of a compressed gas metered dose inhaler with or without a spacer. delivered by inhalation of an aerosol using the breath of the

In one aspect, described herein is an aqueous solution for nebulized inhalation administration, the aqueous solution comprising water, a pirfenidone or pyridone analog compound at a concentration of from about 10 mg/mL to about 50 mg/mL, and , including one or more co-solvents. In another aspect, described herein is an aqueous solution for nebulized inhalation administration, the aqueous solution comprising water, a pirfenidone or pyridone analog compound at a concentration of from about 10 mg/mL to about 50 mg/mL, optionally includes one or more buffers and one or more co-solvents to maintain the pH between about pH 4.0 and about pH 8.0. In some embodiments, the pH of the aqueous solution is from about 4.0 to about 8.0. In some embodiments, the pH of the aqueous solution is from about 6.0 to about 8.0. In some embodiments, an aqueous solution for nebulized inhalation administration is described herein, the aqueous solution comprising water, a pirfenidone or pyridone analog at a concentration from about 0.1 mg/mL to about 60 mg/mL. and one or more co-solvents, and the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 10 mg/mL to about 60 mg/mL. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 10 mg/mL to about 50 mg/mL. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 15 mg/mL to about 50 mg/mL. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 20 mg/mL to about 50 mg/mL. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 25 mg/mL to about 50 mg/mL. In some embodiments, the pirfenidone or pyridone analog compound is at a concentration from about 30 mg/mL to about 50 mg/mL. In some embodiments, the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the osmolality of the aqueous solution is from about 100 mOsmol/kg to about 5000 mOsmol/kg, from about 300 mOsmol/kg to about 5000 mOsmol/kg, from about 400 mOsmol/kg to about 5000 mOsmol/kg, from about 600 mOsmol/kg to about 5000 mOsmol /kg, from about 1000 mOsmol/kg to about 5000 mOsmol/kg, or from about 2000 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the total co-solvent concentration is from about 1% v/v to about 40% v/v. In some embodiments, the total co-solvent concentration is from about 1% v/v to about 30% v/v. In some embodiments, the total co-solvent concentration is from about 1% v/v to about 25% v/v. In some embodiments, one or more co-solvents are selected from ethanol, propylene glycol, and glycerol. In some embodiments, one or more co-solvents are selected from ethanol and propylene glycol. In some embodiments, the aqueous solution contains both ethanol and propylene glycol. In some embodiments, the aqueous solution further comprises one or more additional ingredients selected from surfactants, taste making agents/sweeteners, and salts. In some embodiments, the flavoring/sweetening agent is saccharin or a salt thereof. In some embodiments, the aqueous solution further comprises one or more additional ingredients selected from surfactants and salts. In some embodiments, the surfactant is polysorbate 80 or cetylpyridinium bromide. In some embodiments, the salt is sodium chloride or magnesium chloride. In some embodiments, the surfactant is polysorbate 80 or cetylpyridinium bromide and the salt is sodium chloride or magnesium chloride. In some embodiments, the aqueous solution contains one or more buffers selected from citrate buffers and phosphate buffers. In some embodiments, the aqueous solution includes phosphate buffer. In some embodiments, the aqueous solution includes citrate buffer. In some embodiments, from about 0.5 mL to about 6 mL of an aqueous solution described herein is provided herein.

In some embodiments, the aqueous solution further comprises one or more additional ingredients selected from surfactants, buffers and salts. In some embodiments, the surfactant is polysorbate 80 or cetylpyridinium bromide, the buffer is citrate or phosphate buffer, and the salt is sodium chloride or magnesium chloride.

In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 10 mg/mL to about 60 mg/mL, one or more co-solvents, wherein one or more co-solvents are The total solvent concentration is about 1% v/v to about 40% v/v, and one or more co-solvents are about 1% v/v to about 25% v/v ethanol, about 1% v/v /v to about 25% v/v propylene glycol and about 1% v/v to about 25% v/v glycerol; Contains a phosphate buffer that maintains a pH of about 8.0 from 6.0.

In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 15 mg/mL to about 50 mg/mL, one or more co-solvents, wherein one or more co-solvents are The total amount of solvent is about 1% v/v to about 30% v/v, and the one or more co-solvents are about 1% v/v to about 10% v/v ethanol and about 1% v/v selected from v/v to about 20% v/v propylene glycol, the aqueous solution optionally comprising a phosphate buffer to maintain the pH of the solution at about pH 6.0 to about pH 8.0, wherein and the osmolality of the aqueous solution is from about 400 mOsmol/kg to about 6000 mOsmol/kg.

In some embodiments, the aqueous solutions for nebulized inhalation administration described herein comprise water, a pirfenidone or pyridone analog compound at a concentration of from about 10 mg/mL to about 50 mg/mL, optionally , a phosphate buffer to maintain the pH of the solution at about pH 6.0 to about pH 8.0, about 1% v/v to about 25% v/v ethanol, and about 1% v/v to One or more co-solvents selected from propylene glycol up to about 25% v/v, the total amount of co-solvents being from 1% v/v to 25% v/v. In some embodiments, the aqueous solutions for nebulized inhalation administration described herein comprise water, a pirfenidone or pyridone analog compound at a concentration of about 10 mg/mL to about 50 mg/mL, optionally Contains phosphate buffer to maintain the pH of the solution at about pH 6.0 to about pH 8.0, about 8% v/v ethanol, and about 16% v/v propylene glycol. In some embodiments, the aqueous solutions for nebulized inhalation administration described herein comprise water, a pirfenidone or pyridone analog compound at a concentration of about 10 mg/mL to about 50 mg/mL, optionally Phosphate buffer to maintain the pH of the solution at about pH 6.0 to about pH 8.0, about 1% v/v to about 25% v/v ethanol, and about 1% v/v to about consisting essentially of one or more co-solvents selected from propylene glycol up to 25% v/v, the total amount of co-solvents being from 1% v/v to 25% v/v. In some embodiments, the aqueous solutions for nebulized inhalation administration described herein comprise water, a pirfenidone or pyridone analog compound at a concentration of about 10 mg/mL to about 50 mg/mL, optionally consisting essentially of a phosphate buffer that maintains the pH of the solution at about pH 6.0 to about pH 8.0, about 8% v/v ethanol, and about 16% v/v propylene glycol. In some embodiments, from about 0.5 mL to about 6 mL of the aqueous solutions described herein are described herein.

In some embodiments, a unit dosage suitable for use with a liquid nebulizer is described comprising from about 0.5 mL to about 6 mL of an aqueous solution of pirfenidone or pyridone analog compound, wherein pirfenidone in aqueous solution is Or the concentration of the pyridone analog compound is from about 0.1 mg/mL to about 60 mg/mL. In some embodiments, the aqueous solution contains one or more additives selected from co-solvents, tonicity agents, sweeteners, surfactants, wetting agents, chelating agents, antioxidants, salts, and buffers. Further comprising ingredients, the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the aqueous solution further comprises one or more co-solvents selected from ethanol, propylene glycol and glycerol and one or both of citrate buffer or phosphate buffer. In some embodiments, the aqueous solution comprises a pirfenidone or pyridone analog compound dissolved in water at a concentration from about 15 mg/mL to about 50 mg/mL; phosphate buffer maintained at 8.0, containing one or more co-solvents, wherein the total amount of the one or more co-solvents is from about 1% v/v to about 30% v/v; The above co-solvents are selected from about 1% v/v to about 10% v/v ethanol and about 1% v/v to about 20% v/v propylene glycol, wherein aqueous solution penetration The pressure is from about 400 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the aqueous solution is as described herein.

In some embodiments, kits are described herein that include a unit dose of an aqueous solution of pirfenidone or a pyridone analog as described herein in a container suitable for use with a liquid nebulizer.

In some embodiments, water droplets of pirfenidone or pyridone analog compounds are provided herein, wherein the water droplets have a diameter of less than about 5.0 μm. In some embodiments, the water droplets were generated from a liquid sprayer and an aqueous solution of the pirfenidone or pyridone analog compound. In some embodiments, the aqueous solution of the pirfenidone or pyridone analog compound is as described herein. In some embodiments, the aqueous solution has a pirfenidone or pyridone analog compound concentration of about 0.1 mg/mL to about 60 mg/mL and an osmolality of about 50 mOsmol/kg to about 6000 mOsmol/kg. there is In some embodiments, water droplets are generated by nebulizing an aqueous solution of a pirfenidone or pyridone analog compound described herein with a nebulizer. In some embodiments, the nebulizer is a liquid nebulizer. In some embodiments, the nebulizer is a high efficiency liquid nebulizer.

In some embodiments, provided herein is an aqueous aerosol comprising a plurality of water droplets of a pirfenidone or pyridone analog compound. In some embodiments, described herein is an aqueous aerosol comprising a plurality of water droplets of a pirfenidone or pyridone analog compound, wherein the plurality of water droplets has a volumetric mean diameter of less than about 5.0 μm. (VMD), mass median aerodynamic diameter (MMAD), and/or mass median diameter (MMD). In some embodiments, a plurality of droplets were generated from a liquid sprayer and an aqueous solution of pirfenidone or a pyridone analog compound. In some embodiments, the aqueous solution has a pirfenidone or pyridone analog compound concentration of about 10 mg/mL to about 60 mg/mL and an osmolality of about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, at least 30% of the water droplets in the aerosol have diameters less than about 5 μm. In some embodiments, an aqueous aerosol is produced by nebulizing an aqueous solution of a pirfenidone or pyridone analog compound described herein with a nebulizer. In some embodiments, the nebulizer is a liquid nebulizer. In some embodiments, the nebulizer is a high efficiency bodily fluid nebulizer.

In some embodiments, the nebulizer used in any of the methods described herein is a liquid nebulizer. In some embodiments, the nebulizer used in any of the methods described herein is a jet nebulizer, an ultrasonic nebulizer, a pulsating membrane nebulizer, a vibrating or a sprayer comprising a vibration generator and an aqueous chamber. In some embodiments, the nebulizer used in any of the methods described herein is a nebulizer that includes a vibrating mesh or plate with many holes. In some embodiments, the liquid nebulizer (i) achieves lung deposition of at least 7% of the pirfenidone or pyridone analog compound administered to the mammal, (ii) from about 1.0 μm to about 2.5 μm. (iii) a) droplets of aqueous solution ejected using a high efficiency liquid atomizer of about 1 μm to about 5 μm, b) a volume mean diameter (VMD) of about 1 μm to about 5 μm, and/or c) a mass median diameter (MMD) of about 1 μm to about 5 μm. (iv) providing at least about 30% fine particle fraction (FPF=%≦5 microns) of the liquid spray ejected droplets; (v) providing an output rate of at least 0.1 mL/min; or (vi) providing at least about 25% of the aqueous solution to the mammal.

In some embodiments, the liquid atomizer comprises at least 2, at least 3, at least 4, at least 5 of (i), (ii), (iii), (iv), (v), (vi) characterized as having one or all six. In some embodiments, the aqueous solution comprises (i) at least 5%, at least 6%, at least 7%, at least 8%, at least 9%, at least 10% of the pirfenidone or pyridone analog compound administered to the mammal; , at least 12%, at least 14%, at least 16%, at least 18%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, or at least 80% lung deposition is achieved. In some embodiments, the aqueous solution has a thickness of (ii) from about 1.0 μm to about 2.5 μm, from about 1.2 μm to about 2.3 μm, from about 1.4 μm to about 2.1 μm, or from about 1.5 μm It provides the geometric standard deviation (GSD) of the ejected droplet size distribution of aqueous solutions of about 2.0 μm. In some embodiments, the liquid atomizer has (iii) a) a mass median aerodynamic diameter of the droplets of the aqueous solution emitted by the high efficiency liquid atomizer of less than about 5 μm or from about 1 μm to about 5 μm; (MMAD), b) a volume mean diameter (VMD) of less than about 5 μm or from about 1 μm to about 5 μm, and/or c) a mass median diameter (MMD) of less than about 5 μm or from about 1 μm to about 5 μm. In some embodiments, the liquid sprayer comprises (iv) at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least About 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, or at least about 90% of the droplets ejected from the liquid sprayer have fine particles (FPF = % < 5 microns) )I will provide a. In some embodiments, the liquid nebulizer is (v) at least 0.1 mL/min, at least 0.2 mL/min, at least 0.3 mL/min, at least 0.4 mL/min, at least 0.5 mL/min, at least Provide an output rate of 0.6 mL/min, at least 0.7 mL/min, at least 0.8 mL/min, at least 0.9 mL/min, at least 1.0 mL/min, or less than about 1.0 mL/min. In some embodiments, the liquid sprayer comprises (vi) at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55% of the aqueous solution , at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, or at least about 95%, to the mammal. In some embodiments, the liquid sprayer comprises at least 5%, at least 6%, at least 7%, at least 8%, at least 10%, at least 12%, at least 16%, at least 20%, at least 24%, at least 28% , at least 32%, at least 36%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, or , provides a respirable delivered dose (RDD) of at least 90%.

In some embodiments, a method for the treatment of pulmonary disease in a mammal is described herein comprising administering an aqueous solution comprising a pirfenidone or pyridone analog compound to the mammal using a liquid nebulizer. including the step of administering. In some embodiments, a method for the treatment of pulmonary disease in a mammal is described herein comprising administering an aqueous solution comprising a pirfenidone or pyridone analog compound to the mammal using a liquid nebulizer. wherein the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration of from about 0.1 mg/mL to about 60 mg/mL, and one or more co-solvents; Osmolality is from about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 10 mg/mL to about 60 mg/mL, one or more co-solvents, wherein one or more co-solvents are The total amount of solvent is about 1% v/v to about 40% v/v and one or more co-solvents are about 1% v/v to about 25% v/v ethanol, about 1% v/v from v to about 25% v/v propylene glycol, or from about 1% v/v to about 25% v/v glycerol; Contains a phosphate buffer that maintains a pH of about 8.0. In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 15 mg/mL to about 50 mg/mL, one or more co-solvents, wherein one or more co-solvents are The total amount of solvent is from about 1% v/v to about 30% v/v and one or more co-solvents are from about 1% v/v to about 10% v/v ethanol, or about 1% v/v selected from v/v to about 20% v/v propylene glycol, the aqueous solution optionally comprising a phosphate buffer to maintain the pH of the aqueous solution at about pH 6.0 to about pH 8.0, wherein and the osmolality of the aqueous solution is from about 400 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the nebulizer includes a jet nebulizer, an ultrasonic nebulizer, a pulsatile membrane nebulizer, a nebulizer comprising a vibrating mesh or plate with many holes, or a vibration generator and an aqueous chamber. A nebulizer. In some embodiments, the liquid nebulizer (i) achieves lung deposition of at least 7% of the pirfenidone or pyridone analog compound administered to the mammal, (ii) from about 1.0 μm to about 2.5 μm. (iii) a) the particle size of the aqueous solution droplets emitted by a high efficiency liquid atomizer from about 1 μm to about 5 μm, b) a volume mean diameter (VMD) of about 1 μm to about 5 μm, and/or c) a mass median diameter (MMD) of about 1 μm to about 5 μm, iv) providing at least about 30% fine particle fraction (FPF=%≦5 microns) of the droplets emitted from the liquid atomizer; (v) providing an output rate of at least 0.1 mL/min; or (vi) providing at least about 25% of the aqueous solution to the mammal. In some embodiments, the mammal is human. In some embodiments, the pulmonary disease is pulmonary fibrosis and the mammal is human. In some embodiments, the pulmonary disease is idiopathic pulmonary fibrosis and the mammal is human. In some embodiments, the pulmonary disease is pulmonary arterial hypertension and the mammal is human. In some embodiments, the pulmonary disease is type 1, 2, 3, 4, and 5 pulmonary arterial hypertension and the mammal is human. In some embodiments, the lung disease is cancer and the mammal is human. In some embodiments, the lung cancer is small cell lung cancer and the mammal is human. In some embodiments, the lung cancer is non-small cell lung cancer and the mammal is human. In some embodiments, the lung cancer is large cell carcinoma and the mammal is human. In some embodiments, the lung cancer is mesothelioma and the mammal is human. In some embodiments, the lung cancer is lung carcinoid tumor or bronchial carcinoid and the mammal is human. In some embodiments, the lung cancer is secondary lung cancer resulting from metastatic disease and the mammal is human. In some embodiments, the lung cancer is bronchioloalveolar carcinoma and the mammal is human. In some embodiments, the lung cancer is sarcoma and the mammal is human. In some embodiments, the lung cancer is lymphoma and the mammal is human. In some embodiments, the liquid sprayer sprays about 0.1 mg to about 360 mg of the pirfenidone or pyridone analog compound with a mass median diameter (MMAD) particle size of about 1 micron to about 5 microns in less than about 20 minutes. Deliver to the lungs of mammals.

In some embodiments, the pirfenidone or pyridone analog compound lung tissue Cmax (maximum blood concentration) and/or AUC (area under the concentration curve ) shows pulmonary pulmonary administration of pirfenidone or pyridone analog compounds after a single oral administration of pirfenidone or pyridone analog compounds at a dose that is about 80% to about 120% of the dose administered using a liquid nebulizer. Plasma of pirfenidone or pyridone analog compound approximately equal to or greater than the tissue Cmax and/or AUC and/or obtained after a single administration of an aqueous solution to a mammal using a liquid nebulizer. The Cmax and/or AUC of the pirfenidone or pyridone analog obtained after a single oral administration of the pirfenidone or pyridone analog compound at a dose that is from about 80% to about 120% of the dose administered using a liquid nebulizer. is at least 10% or higher than the plasma Cmax and/or AUC of the compound of In some embodiments, the lung tissue Cmax of the pirfenidone or pyridone analog compound obtained after a single administration of an aqueous solution to a mammal using a liquid nebulizer is about 80% of the dose administered using a liquid nebulizer. higher than the lung tissue Cmax of the pirfenidone or pyridone analog compound obtained after a single oral administration of the pirfenidone or pyridone analog compound at a dose that is about 120% from . In some embodiments, the pulmonary tissue AUC of the pirfenidone or pyridone analog compound obtained after a single administration of an aqueous solution to a mammal using a liquid nebulizer is about 80% of the dose administered using a liquid nebulizer. greater than the lung tissue ACU of the pirfenidone or pyridone analog compound obtained after a single oral administration of the pirfenidone or pyridone analog compound at a dose that is about 120% from . In some embodiments, the plasma Cmax of the pirfenidone or pyridone analog compound obtained after administration of a single dose of an aqueous solution to a mammal using a liquid nebulizer is from about 80% of the dose administered using a liquid nebulizer. At least 10% or higher than the plasma Cmax of the pirfenidone or pyridone analog compound obtained after a single oral administration of the pirfenidone or pyridone analog compound at a dose that is about 120%. In some embodiments, the plasma AUC of the pirfenidone or pyridone analog compound obtained after administration of a single dose of an aqueous solution to a mammal using a liquid nebulizer is from about 80% of the dose administered using a liquid nebulizer. At least 10% or greater of the plasma AUC of the pirfenidone or pyridone analog compound obtained after a single oral administration of the pirfenidone or pyridone analog compound at a dose that is about 120%.

In some embodiments, the liquid nebulizer delivers from about 0.1 mg to about 360 mg of the pirfenidone or pyridone analog compound to the lungs of the mammal with a mass median diameter (MMAD) particle size of from about 1 micron to about 5 microns. in less than about 20 minutes.

In some embodiments, administration with a liquid nebulizer does not include an initial dose titration period.

In some embodiments, methods of reducing the risk of gastrointestinal (GI) adverse events in human treatment with pirfenidone or pyridone analog compounds are described herein, the methods comprising using a liquid nebulizer. , administering to a human a nebulized aqueous solution comprising a pirfenidone human or pyridone analog compound, wherein the aqueous solution is water, pirfenidone or pyridone at a concentration of from about 0.1 mg/mL to about 60 mg/mL. and one or more co-solvents, and the osmolality of the aqueous solution is from about 50 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 10 mg/mL to about 60 mg/mL, and one or more co-solvents, wherein one or more is from about 1% v/v to about 40% v/v, one or more cosolvents are from about 1% v/v to about 25% v/v ethanol, about 1% v/v propylene glycol at v/v to about 25% v/v, or glycerol at about 1% v/v to about 25% v/v; Contains a phosphate buffer that maintains a pH of 0 to about 8.0.

In some embodiments, the aqueous solution comprises water, a pirfenidone or pyridone analog compound at a concentration from about 15 mg/mL to about 50 mg/mL, and one or more co-solvents, wherein one or more is about 1% v/v to about 30% v/v, one or more cosolvents is about 1% v/v to about 10% v/v ethanol, or about selected from 1% v/v to about 20% v/v propylene glycol, the aqueous solution optionally comprising a phosphate buffer to maintain the pH of the aqueous solution at about pH 6.0 to about pH 8.0; , wherein the osmolality of the aqueous solution is from about 400 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, a pirfenidone or pyridone analog is administered to treat pulmonary disease in humans. In some embodiments, the lung disease is idiopathic pulmonary fibrosis.

In some embodiments, the liquid sprayer sprays about 0.1 mg to about 360 mg of the pirfenidone or pyridone analog compound with a mass median diameter (MMAD) particle size of about 1 micron to about 5 microns in less than about 20 minutes. Deliver to the lungs.

In some embodiments, administration with a liquid nebulizer does not include an initial dose titration period.

In some embodiments, from about 0.5 mL to about 6 mL of an aqueous solution is administered to the mammal via a liquid nebulizer, the aqueous solution containing from about 0.1 mg/mL to about 60 mg/mL of the pirfenidone or pyridone analog. The concentration of the compound is such that the aqueous solution has an osmolality of about 50 mOsmol/kg to about 5000 mOsmol/kg, and the liquid nebulizer is a nebulizer containing a vibrating mesh or plate with many holes.

In some embodiments, the liquid sprayer sprays about 0.1 mg to about 360 mg of the pirfenidone or pyridone analog compound with a mass median diameter (MMAD) particle size of about 1 micron to about 5 microns in less than about 20 minutes. Deliver to the lungs. In some embodiments, the aqueous solution has a pH of about 4.0 to about 8.0 and an osmolality of about 400 mOsmol/kg to about 5000 mOsmol/kg.

In some embodiments, an inhalation system for administering a pirfenidone or pyridone analog compound to the respiratory tract of humans is described herein, the inhalation system comprising: (a) about 0.5 mL to about 6 mL of pirfenidone; or an aqueous solution of a pyridone analogue compound; and (b) a highly efficient liquid atomizer. In some embodiments, the aqueous solution is any of the aqueous solutions described herein. In some embodiments, the concentration of the pirfenidone or pyridone analog compound in the aqueous solution is from about 0.1 mg/mL to about 60 mg/mL and the osmolality of the aqueous solution is from about 400 mOsmol/kg to about 6000 mOsmol/kg. is. In some embodiments, the aqueous solution comprises water, the pirfenidone or pyridone analog compound at a concentration of from about 10 mg/mL to about 50 mg/mL, and optionally the pH of the aqueous solution from about pH 6.0 to about pH 8.0. Phosphate buffer maintained at 0, about 1% to about 8% ethanol, and/or about 2% to about 16% propylene glycol. In some embodiments, the aqueous solution is as described herein.

In one embodiment, at least 1.5-fold, at least 2-fold, at least 3-fold, at least 4-fold, at least 5-fold, at least 6-fold the Cmax of the pirfenidone or pyridone analog compound at an orally administered amount of up to 801 mg, at least 1.5-fold, at least 1.5-fold, at least 1.5-fold, at least 1.5-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 1.5-20-fold, at least Lung tissue Cmax of a pirfenidone or pyridone analog compound that is 1.5-15-fold, at least 1.5-10-fold, at least 1.5-5-fold, or at least 1.5-3-fold A method for achieving is described herein comprising nebulizing an aqueous solution comprising a pirfenidone or pyridone analogue compound and administering the nebulized aqueous solution to a human. In some embodiments, a lung tissue Cmax of the pirfenidone or pyridone analog compound that is at least equal to or greater than the Cmax of the pirfenidone or pyridone analog compound at an orally administered amount of up to 801 mg is achieved. A method is described herein comprising nebulizing an aqueous solution comprising a pirfenidone or pyridone analog compound and administering the nebulized aqueous solution to a human.

In one embodiment, at least 1.5- _fold , at least 2-fold, at least 3-fold, at least 4-fold, at least 5-fold, at least 6-fold, at least 1.5-fold, at least 1.5-fold, at least 1.5-fold, at least 1.5-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 1.5-fold-20 fold, at least 1.5x-15x, at least 1.5x-10x, at least 1.5x-5x, or at least 1.5x-3x. A method of achieving lung tissue AUC _0-24 for a pirfenidone or pyridone analog compound is described herein comprising the steps of: nebulizing an aqueous solution comprising a pirfenidone or pyridone analog compound; The step of administering the aqueous solution to a human is included. In some embodiments, pirfenidone or pyridone analog compound lungs at an orally administered amount of up to 801 mg that is at least equal to or greater than the AUC _0-24 of the pirfenidone or pyridone analog compound A method of achieving a tissue AUC _0-24 is described herein comprising nebulizing an aqueous solution comprising a pirfenidone or pyridone analog compound and administering the nebulized aqueous solution to a human. include.

In one aspect, described herein is a method of administering a pirfenidone or pyridone analog compound to a human, the method comprising administering a nebulized aqueous solution comprising the pirfenidone or pyridone analog compound, The pulmonary tissue Cmax achieved with the nebulized aqueous solution was achieved at doses of orally administered pirfenidone or pyridone analog compounds that were 80% to 120% of the dose of pirfenidone administered by nebulization. at least 1.5 times, at least 2 times, at least 3 times, at least 4 times, at least 5 times, at least 6 times, at least 1.5 times, at least 1.5 times, at least 1.5 times, at least 1.5-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 1.5-20-fold, at least 1.5-15-fold, at least 1.5-10-fold, at least 1.5-fold 5 times, or at least 1.5-3 times.

In one aspect, described herein is a method of administering a pirfenidone or pyridone analogue compound to a human, the method comprising administering a nebulized aqueous solution comprising pirfenidone or a pyridone analogue, wherein the nebulized pirfenidone or pyridone analog compound orally administered pirfenidone or pyridone analog compound, wherein the pulmonary tissue Cmax achieved in the aqueous solution is 80% to 120% of the dose of pirfenidone or pyridone analog compound in a nebulized aqueous solution of pirfenidone or pyridone analog compound at least 1.5-fold, at least 2-fold, at least 3-fold, at least 4-fold, at least 5-fold, at least 6-fold, at least 1.5-fold, at least 1-fold the lung tissue Cmax achieved at the dose of the analog compound of .5-fold, at least 1.5-fold, at least 1.5-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 1.5-20-fold, at least 1.5-15-fold, at least 1-fold .5-10 times, at least 1.5-5 times, or at least 1.5-3 times. In some embodiments, methods of administering a pirfenidone or pyridone analog compound to a human are described herein, the method comprising administering a nebulized aqueous solution comprising pirfenidone or a pyridone analog, The pulmonary tissue Cmax achieved with the nebulized aqueous solution is 80% to 120% of the dose of the pirfenidone or pyridone analog compound in the nebulized aqueous solution of the pirfenidone or pyridone analog compound administered orally. is at least equal to or higher than the lung tissue Cmax achieved at the dose of pirfenidone or pyridone analog compound administered.

In some embodiments, methods of administering a pirfenidone or pyridone analog compound to a human are described herein, the method comprising administering a nebulized aqueous solution comprising pirfenidone or a pyridone analog, The plasma AUC _0-24 achieved with the nebulized aqueous solution is 80% to 120% of the dose of the administered pirfenidone or pyridone analog compound in the nebulized aqueous solution of the pirfenidone or pyridone analog compound, At least 10% of or greater than the plasma AUC _0-24 achieved at the dose of orally administered pirfenidone or pyridone analog compound.

In one aspect, described herein is a method of administering a pirfenidone or pyridone analogue compound to a human, the method comprising administering a nebulized aqueous solution comprising pirfenidone or a pyridone analogue, wherein the nebulized The pulmonary tissue AUC _0-24 achieved in the aqueous solution was 80% to 120% of the dose of the pirfenidone or pyridone analog compound in the nebulized aqueous solution of the pirfenidone or pyridone analog compound administered orally. at least 1.5-fold, at least 2-fold, at least 3-fold, at least 4-fold, at least 5-fold, at least 6-fold, at least 1.0-fold the lung tissue AUC _0-24 achieved at the dose of the pirfenidone or pyridone analog compound. 5-fold, at least 1.5-fold, at least 1.5-fold, at least 1.5-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 1.5-20-fold, at least 1.5-fold 15 times, at least 1.5-10 times, at least 1.5-5 times, or at least 1.5-3 times. In some embodiments, methods of administering a pirfenidone or pyridone analog compound to a human are described herein, the method comprising administering a nebulized aqueous solution comprising pirfenidone or a pyridone analog, The pulmonary tissue AUC _0-24 achieved with the nebulized aqueous solution is 80% to 120% of the dose of the pirfenidone or pyridone analogue compound in the nebulized aqueous solution of the pirfenidone or pyridone analogue compound. at least 1.5 times the lung tissue AUC _0-24 achieved with the pirfenidone or pyridone analog compound dose administered.

In one aspect, provided herein are methods of improving the pharmacokinetic profile obtained in humans following a single oral administration of pirfenidone or a pyridone analogue. In some embodiments, a pirfenidone or pyridone analog is administered to a human to treat pulmonary disease. In some embodiments, the pulmonary disease is pulmonary fibrosis. In some embodiments, the lung disease is idiopathic pulmonary fibrosis. In some embodiments, a single oral dose comprises up to about 801 mg of the pirfenidone or pyridone analog compound. In some embodiments, the method of improving the pharmacokinetic profile comprises administering the pirfenidone or pyridone analog by inhalation. In some embodiments, the pharmacokinetic profile comprises a lung tissue pharmacokinetic profile. In some embodiments, the pharmacokinetic profile comprises a lung tissue pharmacokinetic profile and/or a plasma pharmacokinetic profile. In some embodiments, the pirfenidone or pyridone analog is administered as an aqueous solution using a liquid nebulizer. In some embodiments, the aqueous solution of pirfenidone or pyridone analog is as described herein. In some embodiments, the method of improving the pharmacokinetic profile further comprises comparing a pharmacokinetic parameter after inhaled administration to the same parameter obtained after oral administration. In some embodiments, the improved pharmacokinetic profile is about the same as depicted in FIG. In some embodiments, the initial improvement in pharmacokinetic profile is similar to that depicted in FIG. 1, but the half-life in the lung is increased, providing longer residence time in the lung. In some embodiments, a sustained improvement in the pharmacokinetic profile is obtained by repeated and frequent administration of an aqueous solution of pirfenidone or a pyridone analogue as described herein by inhalation. In some embodiments, continuous administration of pirfenidone or pyridone analogs by inhalation provides more frequent direct lung exposures that benefit humans through repeated high Cmax levels. In some embodiments, the dose of inhaled pirfenidone or pyridone analog is once daily, twice daily, three times daily, four times daily, every other day, every two days, every three days. , every 4 days, every 5 days, every 6 days, every 7 days, or a combination thereof. In some embodiments, the improved pharmacokinetic profile is about the same as depicted in FIG. In some embodiments, the initial improvement in pharmacokinetic profile is similar to that depicted in FIG. 2, but the lung half-life is increased, providing longer residence time in the lung. In some embodiments, a sustained improvement in the pharmacokinetic profile is obtained by repeated and frequent administration of an aqueous solution of pirfenidone or a pyridone analogue as described herein by inhalation. In some embodiments, continuous administration of pirfenidone or pyridone analogs by inhalation provides more frequent direct lung exposures that benefit humans through repeated high Cmax levels. In some embodiments, the dose of inhaled pirfenidone or pyridone analog is once daily, twice daily, three times daily, four times daily, every other day, every two days, every three days. , every 4 days, every 5 days, every 6 days, every 7 days, or a combination thereof. In some embodiments, the improved pharmacokinetic profile is approximately the same as depicted in FIG. In some embodiments, the initial improvement in pharmacokinetic profile is similar to that depicted in FIG. 5, but the lung half-life is increased, providing longer residence time in the lung. In some embodiments, a sustained improvement in the pharmacokinetic profile is obtained by repeated and frequent administration of an aqueous solution of pirfenidone or a pyridone analogue as described herein by inhalation. In some embodiments, continuous administration of pirfenidone or pyridone analogs by inhalation provides more frequent direct lung exposures that benefit humans through repeated high Cmax levels. In some embodiments, the dose of inhaled pirfenidone or pyridone analog is once daily, twice daily, three times daily, four times daily, every other day, every two days, every three days. , every 4 days, every 5 days, every 6 days, every 7 days, or a combination thereof.

In some embodiments, a lung comprising a solution of pirfenidone or a pyridone analog having a concentration greater than about 34 mcg/mL, an osmolarity greater than about 100 mOsmol/kg, and a pH greater than about 4.0. Pharmaceutical compositions for delivery are described herein. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the composition includes a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the composition includes a mucolytic agent suitable for pulmonary delivery. In some embodiments, the composition includes a second antifibrotic drug suitable for pulmonary delivery. In some embodiments, the composition includes a second anti-inflammatory agent suitable for pulmonary delivery.

In some embodiments, pharmaceutical compositions for pulmonary delivery are described herein comprising a solution of pirfenidone or a pyridone analogue and a flavoring agent, wherein the solution has a concentration of greater than about 100 mOsmol/kg. It has an osmotic pressure and a pH greater than about 4.0. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 34 mcg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 1.72 mg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the composition includes a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the composition includes a mucolytic agent suitable for pulmonary delivery.
In some embodiments, the composition includes a second antifibrotic drug suitable for pulmonary delivery. In some embodiments, the composition includes a second anti-inflammatory agent suitable for pulmonary delivery.

In some embodiments, about 0.1 mL to about 20 mL of pirfenidone or A sterile, disposable container containing a solution of a pyridone analog is described herein. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the container further comprises a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the container further comprises a mucolytic agent suitable for pulmonary delivery. In some embodiments, the container further comprises a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the container further comprises a second anti-inflammatory agent suitable for pulmonary delivery.

In one aspect, inhaling an aerosol of a pirfenidone or pyridone analog solution having a concentration greater than about 34 mcg/mL, an osmolality greater than about 100 mOsmol/kg, and a pH greater than about 4.0. Described herein are methods for treating pulmonary disease, including: In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the lung disease is interstitial lung disease. In some embodiments, the interstitial lung disease is idiopathic pulmonary fibrosis. In some embodiments, the interstitial lung disease is radiation therapy-induced pulmonary fibrosis. In some embodiments, the pulmonary disease is chronic obstructive pulmonary disease. In some embodiments, the lung disease is chronic bronchitis. In some embodiments, the lung disease is asthma. In some embodiments, the aerosol contains particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 5 microns and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 1.7 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In some embodiments, described herein are pharmaceutical compositions for pulmonary delivery comprising a solution of pirfenidone or a pyridone analog and a flavoring agent, wherein the solution is greater than about 50 mOsmol/kg by weight. osmolality, and pH greater than about 4.0. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 34 mcg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 1.72 mg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, the composition includes a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the composition includes a mucolytic agent suitable for pulmonary delivery. In some embodiments, the composition includes a second antifibrotic agent suitable for pulmonary delivery. In some embodiments, the composition includes a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the composition includes a second anti-cancer agent suitable for pulmonary delivery. In some embodiments, the composition comprises a second anti-pulmonary hypertension agent suitable for pulmonary delivery.

In one aspect, described herein is a method of treating pulmonary disease, wherein the method comprises a concentration greater than about 34 mcg/mL, an osmolality greater than about 50 mOsmol/kg, and an osmolality greater than about 4.0. Inhaling an aerosol of a solution of pirfenidone or a pyridone analog having a pH. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 0.1 mg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second antifibrotic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the lung disease is interstitial lung disease and the mammal is human. In some embodiments, the interstitial lung disease is idiopathic pulmonary fibrosis and the mammal is human. In some embodiments, the interstitial lung disease is radiation therapy-induced pulmonary fibrosis and the mammal is a human. In some embodiments, the pulmonary disease is chronic obstructive pulmonary disease and the mammal is human. In some embodiments, the lung disease is chronic bronchitis and the mammal is human. In some embodiments, the pulmonary disease is asthma and the mammal is human. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size of about 1 micron to about 5 microns volumetric mean diameter and a geometric standard deviation of particle size of 3 microns or less. In some embodiments, inhaling delivers a minimum dose of pirfenidone or pyridone analog of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum 1.7 mg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling is performed in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In one aspect, described herein is a method of treating pulmonary disease, comprising a concentration greater than about 34 mcg/mL, an osmolality greater than about 100 mOsmol/kg, and an osmolality greater than about 4.0. Inhaling an aerosol of a solution of pirfenidone or a pyridone analog having a pH. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 0.1 mg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering an anti-fibrotic or anti-cancer, anti-pulmonary hypertension or anti-infective agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the compositions may be co-administered with anti-fibrotic or anti-cancer, anti-pulmonary hypertension or anti-infective agents suitable for pulmonary delivery. In some embodiments, the composition is co-administered with a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second antifibrotic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the lung disease is lung cancer. In some embodiments, the lung cancer is small cell lung cancer. In some embodiments, the lung cancer is non-small cell lung cancer. In some embodiments, the lung cancer is large cell carcinoma. In some embodiments, the lung cancer is mesothelioma. In some embodiments, the lung cancer is lung carcinoid tumor or bronchial carcinoid. In some embodiments, the lung cancer is secondary lung cancer resulting from metastatic disease. In some embodiments, the lung cancer is bronchioloalveolar carcinoma. In some embodiments, the lung cancer can be sarcoma. In some embodiments, the lung cancer can be lymphoma. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size of about 1 micron to about 5 microns volumetric mean diameter and a geometric standard deviation of particle size of 3 microns or less. In some embodiments, inhaling delivers a minimum 6.8 mcg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum 1.7 mg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In one aspect, described herein is a method of treating pulmonary disease, comprising a concentration greater than about 34 mcg/mL, an osmolality greater than about 100 mOsmol/kg, and an osmolality greater than about 4.0. Inhaling an aerosol of a solution of pirfenidone or a pyridone analog having a pH. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 0.1 mg/mL. In some embodiments, the concentration of pirfenidone or pyridone analog is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 50 mOsmol/kg to about 2000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering an anti-fibrotic or anti-cancer, anti-pulmonary hypertension or anti-infective agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the compositions may be co-administered with anti-fibrotic or anti-cancer, anti-pulmonary hypertension or anti-infective agents suitable for pulmonary delivery. In some embodiments, the composition is co-administered with a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second antifibrotic agent suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the lung disease is pulmonary hypertension. In some embodiments, the pulmonary hypertension is type 1. In some embodiments, the pulmonary hypertension is type 2. In some embodiments, the pulmonary hypertension is type 3. In some embodiments, the pulmonary hypertension is type 4. In some embodiments, the pulmonary hypertension is type 5. In some embodiments, pulmonary hypertension is associated with pulmonary fibrosis. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size of about 1 micron to about 5 microns volumetric mean diameter and a geometric standard deviation of particle size of 3 microns or less. In some embodiments, inhaling delivers a minimum 6.8 mcg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum 1.7 mg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In one aspect, a method of administering an anti-fibrotic agent to the lungs of a patient is described herein, comprising: a concentration greater than about 34 mcg/mL; Introducing a pirfenidone or pyridone analog solution having a pH greater than about 4.0 into the nebulizer. In another aspect, described herein is a method of administering an anti-inflammatory agent to the lungs of a patient, comprising: a concentration greater than about 34 mcg/mL; an osmolality greater than about 100 mOsmol/kg; Introducing a pirfenidone or pyridone analog concentration having a pH greater than 4.0 into the nebulizer. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the mucolytic agent is inhaled separately from the pirfenidone or pyridone analog solution. In some embodiments, the method further comprises administering a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery.

In one aspect, a concentration greater than about 34 mcg/mL to absorb the delivered pirfenidone or pyridone analog into the pulmonary vasculature and expose downstream disease targets to the delivered pirfenidone or pyridone analog; A method for treating extrapulmonary disease targets comprising inhaling an aerosol of a pirfenidone or pyridone analogue solution having an osmolality greater than about 100 mOsmol/kg and a pH greater than about 4.0 is present. Described in the specification. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for pulmonary delivery. In some embodiments, the mucolytic agent is inhaled separately from the pirfenidone or pyridone analog solution. In some embodiments, the method further comprises administering a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for pulmonary delivery. In some embodiments, the extrapulmonary disease target is the heart. In some embodiments, the extrapulmonary disease target is the kidney. In some embodiments, the extrapulmonary disease target is the liver.

In any of the methods described herein using an aerosol or nebulizer to deliver a pirfenidone or pyridone analog compound to the lung, the aerosol has an average aerodynamic diameter of about 1 micron to about 5 microns. It contains particles having a diameter. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 5 microns, and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, the step of inhaling delivers a minimum 17 mg pirfenidone or pyridone analog dose. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In one aspect, intranasal inhalation of an aerosol of a pirfenidone or pyridone analog solution having a concentration greater than about 34 mcg/mL, an osmolality greater than about 100 mOsmol/kg, and a pH greater than about 4.0. Described herein are methods of treating neurological disorders, including: In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the aerosol further comprises a taste masking agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for intranasal delivery. In some embodiments, the method further comprises administering a second anti-fibrotic agent suitable for intranasal delivery. In some embodiments, the method further comprises administering a second anti-inflammatory agent suitable for intranasal delivery. In some embodiments, the neurological disease is multiple sclerosis. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 20 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 20 microns, and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 1.7 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths.

In some embodiments, methods of administering an anti-demylinating agent to the nasal passages of a patient are described herein, the methods comprising a concentration greater than about 34 mcg/mL and a concentration greater than about 100 mOsmol/kg. Introducing a pirfenidone or pyridone analog solution having a high osmotic pressure and a pH greater than about 4.0 into the nebulizer. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the solution further comprises a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the method further comprises administering a mucolytic agent suitable for intranasal delivery. In some embodiments, the mucolytic agent is inhaled separately from the pirfenidone or pyridone analog solution. In some embodiments, the method further comprises administering a second agent suitable for intranasal delivery.

In any of the methods described herein comprising introducing a pirfenidone or pyridone analog solution into the nebulizer, the method comprises about 0.5 mL to about 10 mL of pirfenidone or pyridone analog solution for introduction into the nebulizer. It involves opening a sterile disposable container containing the analog solution.

In any of the methods described herein involving a nebulizer, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 5 microns and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 20 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 20 microns, and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 1.7 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, the step of inhaling occurs in less than about 20 minutes. In some embodiments, inhaling is performed in less than about 10 minutes. In some embodiments, the step of inhaling occurs in less than about 7.5 minutes. In some embodiments, the step of inhaling occurs in less than about 5 minutes. In some embodiments, the step of inhaling occurs in less than about 2.5 minutes. In some embodiments, the step of inhaling occurs in less than about 1.5 minutes. In some embodiments, inhaling occurs in less than about 30 seconds. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths. In some embodiments, the step is performed in one breath.

In one aspect, a pharmaceutical composition comprising a pirfenidone or pyridone analog solution in a sterile container, wherein the pirfenidone or pyridone analog solution has a concentration greater than about 34 mcg/mL and an osmolality greater than about 100 mOsmol/kg. and a pharmaceutical composition having a pH greater than about 4.0; and a nebulizer suitable for aerosolizing a solution of pirfenidone or a pyridone analogue for delivery from the central to the lower respiratory tract via oral inhalation; Kits are provided herein. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the solution further comprises a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the kit further comprises a mucolytic agent suitable for pulmonary delivery. In some embodiments, the kit further comprises a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the kit further comprises a second anti-inflammatory agent suitable for pulmonary delivery.

In another aspect, a pharmaceutical composition comprising a pirfenidone or pyridone analog solution in a sterile container, wherein the pirfenidone or pyridone analog solution has a concentration greater than about 34 mcg/mL and an osmolality greater than about 100 mOsmol/kg. a pharmaceutical composition having a pH greater than about 4.0; and a nebulizer suitable for aerosolizing a pirfenidone or pyridone analog solution for delivery to the nasal cavity via intranasal inhalation. provided in the specification.

In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 1.72 mg/mL. In some embodiments, the pirfenidone or pyridone analog concentration is greater than about 86 mg/mL. In some embodiments, the pirfenidone or pyridone analog solution has a permeant ion concentration of about 30 mM to about 300 mM. In some embodiments, the permeating ion is chloride or bromide. In some embodiments, the pirfenidone or pyridone analog solution has a pH of about 4.0 to about 8.0. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality from about 100 mOsmol/kg to about 1000 mOsmol/kg. In some embodiments, the pirfenidone or pyridone analog solution has an osmolality of from about 50 mOsmol/kg to about 5000 mOsmol/kg. In some embodiments, the solution further comprises a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, and citrate. In some embodiments, the kit further comprises a mucolytic agent suitable for intranasal delivery. In some embodiments, the kit further comprises a second anti-fibrotic drug suitable for intranasal delivery. In some embodiments, the kit further comprises a second anti-inflammatory agent suitable for intranasal delivery.

In one aspect, described herein is a method for treating pulmonary disease, comprising having or having interstitial lung disease via oral inhalation of an aerosol comprising a pirfenidone or pyridone analog. administering a pirfenidone or pyridone analogue to the central to lower respiratory tract of a subject suspected of having a disease wherein the disease is interstitial lung including idiopathic pulmonary fibrosis and radiation therapy-induced fibrosis. disease, chronic obstructive pulmonary disease, and asthma. In some embodiments, the subject is confirmed to have interstitial lung disease. In some embodiments, the subject is confirmed to have idiopathic pulmonary fibrosis. In some embodiments, the subject is confirmed to have radiation therapy-induced fibrosis. In some embodiments, the subject is confirmed to have chronic obstructive pulmonary disease. In some embodiments, the subject is confirmed to have chronic bronchitis. In some embodiments, the subject is confirmed to have asthma. In some embodiments, the subject is a mechanically ventilated subject.

A method for treating extrapulmonary disease is via oral inhalation of an aerosol containing pirfenidone or pyridone analogues for pulmonary vascular absorption and delivery to extrapulmonary diseased tissue. /or administering pirfenidone or a pyridone analog to the central to lower respiratory tract of a subject having or suspected of having a toxicity-related disease, wherein the disease is cardiac fibrosis, renal fibrosis, selected from liver fibrosis, nephrotoxicity and cardiotoxicity; In some embodiments, the subject is confirmed to have cardiac fibrosis. In some embodiments, the subject is confirmed to have renal fibrosis. In some embodiments, the subject is confirmed to have liver fibrosis. In some embodiments, the subject is confirmed to have renal toxicity. In some embodiments, the subject is confirmed to have cardiotoxicity. In some embodiments, the subject is a ventilated subject.

In one embodiment, a subject having or suspected of having a neurological disorder via intranasal inhalation of an aerosol comprising pirfenidone or a pyridone analogue for nasal vascular absorption and delivery to the central nervous system. A method for treating a neurological disease is described herein comprising administering pirfenidone or a pyridone analog to the nasal cavity of a patient, wherein the disease is multiple sclerosis. In some embodiments, the subject is confirmed to have multiple sclerosis. In some embodiments, the subject is a ventilated subject.

In one aspect, described herein are pharmaceutical compositions for pulmonary delivery comprising a dry powder containing a pirfenidone or pyridone analog having a dosage content of greater than about 1%. . In some embodiments, the pirfenidone or pyridone analog dose content is greater than about 6.8 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 340 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 17 mg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 463 mg. In some embodiments, the powder further comprises an admixture. In some embodiments, the admixture is selected from the group consisting of lactose.

In one aspect, described herein is a pharmaceutical composition for pulmonary delivery comprising a dry powder containing a pirfenidone or pyridone analog having a dosage content of greater than about 1%. In yet another aspect, described herein is a sterile disposable container containing from about 0.5 mg to about 100 mg of dry powder containing a pirfenidone or pyridone analog having a dosage content of greater than about 1%. . In a further aspect, a method of treating pulmonary disease comprising inhaling a dry powder aerosol comprising a pirfenidone or pyridone dose content greater than about 1% is described. In some embodiments, the pirfenidone or pyridone analog dosage content is greater than about 6.8 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 340 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 17 mg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 463 mg. In some embodiments, the dry powder further comprises an admixture. In some embodiments, the admixture is lactose. In some embodiments, the lung disease is interstitial lung disease. In some embodiments, the interstitial lung disease is idiopathic pulmonary fibrosis. In some embodiments, the interstitial lung disease is radiation therapy-induced pulmonary fibrosis. In some embodiments, the pulmonary disease is chronic obstructive pulmonary disease. In some embodiments, the lung disease is chronic bronchitis. In some embodiments, the lung disease is asthma. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 5 microns and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 1.7 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths. In some embodiments, inhaling is performed within less than about 2 breaths. In some embodiments, the step is performed in one breath.

In one aspect, administering an anti-fibrotic agent to the lungs of a subject comprising introducing a dry powder formulation of a pirfenidone or pyridone analog having a dose content greater than about 1% into a dry powder inhaler. A method for doing is provided herein. In another aspect, administering an anti-inflammatory agent to the lungs of a subject comprising introducing a dry powder formulation of a pirfenidone or pyridone analog having a dose content greater than about 1% into a dry powder inhaler. A method is provided herein. In yet another aspect, provided herein are methods for treating extrapulmonary disease targets comprising inhaling a dry powder aerosol comprising a pirfenidone or pyridone dose content greater than about 1%. In some embodiments, the extrapulmonary disease target is the heart. In some embodiments, the extrapulmonary disease target is the kidney. In some embodiments, the extrapulmonary disease target is the liver. In yet another aspect, provided herein are methods for treating neurological disorders comprising intranasal inhalation of a dry powder aerosol comprising a pirfenidone or pyridone dose content greater than about 1%. In some embodiments, the neurological disease is multiple sclerosis. In yet another aspect, administering a pirfenidone or pyridone analog dry powder formulation having a dosage content greater than about 1% into a dry powder inhaler. Methods of administering are provided herein. In some embodiments, the pirfenidone or pyridone analog dosage content is greater than about 6.8 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 340 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 17 mg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 463 mg. In some embodiments, the dry powder includes an admixture. In some embodiments, the admixture is lactose. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 5 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 5 microns and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, the aerosol comprises particles having an average aerodynamic diameter of about 1 micron to about 20 microns. In some embodiments, the aerosol has a mean particle size with a volume mean diameter of about 1 micron to about 20 microns and a particle size geometric standard deviation of less than or equal to 3 microns. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 6.8 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 340 mcg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 740 mcg. In some embodiments, the step of inhaling delivers a minimum pirfenidone or pyridone analog dose of 1.7 mg. In some embodiments, the step of inhaling delivers a minimum pirfenidone or pyridone analog dose of 17 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 93 mg. In some embodiments, inhaling delivers a minimum pirfenidone or pyridone analog dose of 463 mg. In some embodiments, inhaling is performed within less than about 5 breaths. In some embodiments, inhaling is performed within less than about 3 breaths. In some embodiments, inhaling is performed within less than about 2 breaths. In some embodiments, the step is performed during one breath. In some embodiments, the method further comprises opening a disposable dry powder container containing about 0.5 mg to about 10 mg of a dry powder formulation comprising a pirfenidone or pyridone analog for introduction into the dry powder inhaler. .

In one aspect, a pharmaceutical composition comprising a dry powder pirfenidone or pyridone analog formulation in a container, wherein the pirfenidone or pyridone analog dose content is greater than about 1%, and oral inhalation. A dry powder inhaler suitable for aerosolizing a dry powder formulation of a pirfenidone or pyridone analogue for delivery from the central respiratory tract to the lower respiratory tract is described herein. In another aspect, a pharmaceutical composition comprising a dry powder pirfenidone or pyridone analog formulation in a container, wherein the pirfenidone or pyridone analog dosage content is greater than about 1%, and intranasal inhalation. A dry powder inhaler suitable for aerosolizing a dry powder formulation of pirfenidone or a pyridone analogue for delivery to the nasal passages via the kit is described herein. In some embodiments, the pirfenidone or pyridone analog dosage content is greater than about 6.8 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 340 mcg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 17 mg. In some embodiments, the pirfenidone or pyridone analog content is greater than about 463 mg. In some embodiments, the dry powder further comprises an admixture. In some embodiments, the admixture is lactose.

In one aspect, a method for treating pulmonary disease is described herein comprising having or having interstitial lung disease via oral inhalation of an aerosol comprising a pirfenidone or pyridone analogue. administering a pirfenidone or pyridone analogue to the central to lower respiratory tract of a subject suspected of having a disease wherein the disease is interstitial lung including idiopathic pulmonary fibrosis and radiation therapy-induced fibrosis. disease, chronic obstructive pulmonary disease, and asthma. In some embodiments, the subject is confirmed to have interstitial lung disease. In some embodiments, the subject is confirmed to have idiopathic pulmonary fibrosis. In some embodiments, the subject is confirmed to have radiation therapy-induced pulmonary fibrosis. In some embodiments, the subject is confirmed to have chronic obstructive pulmonary disease. In some embodiments, the subject is confirmed to have chronic bronchitis. In some embodiments, the subject is confirmed to have asthma. In some embodiments, the subject is a ventilated subject.

In one aspect, described herein is a method of treating pulmonary disease in a subject having or suspected of having pulmonary disease via oral inhalation of an aerosol comprising pirfenidone or a pyridone analogue. wherein the pulmonary disease is cancer. In some embodiments, the lung cancer therapeutic target is the tumor stroma. In some embodiments, the subject is a ventilated subject.

In one aspect, described herein is a method of treating pulmonary disease in a subject having or suspected of having pulmonary disease via oral inhalation of an aerosol comprising pirfenidone or a pyridone analogue. administering pirfenidone or a pyridone analog to the middle to lower airways of the lung, wherein the pulmonary disease is pulmonary hypertension. In some embodiments, the subject is a ventilated subject.

In one embodiment, diseases associated with extrapulmonary fibrosis, inflammation and/or toxicity via oral inhalation of an aerosol comprising pirfenidone or pyridone analogs for pulmonary vascular absorption and delivery to extrapulmonary diseased tissue. Described herein are methods for treating extrapulmonary disease comprising administering pirfenidone or a pyridone analog to the lower respiratory tract of a subject having or suspected of having The disease is selected from cardiac fibrosis, renal fibrosis, liver fibrosis, nephrotoxicity and cardiotoxicity.

In some embodiments, the subject is confirmed to have cardiac fibrosis. In some embodiments, the subject is confirmed to have renal fibrosis. In some embodiments, the subject is confirmed to have liver fibrosis. In some embodiments, the subject is confirmed to have renal toxicity. In some embodiments, the subject is confirmed to have cardiotoxicity. In some embodiments, the subject is a ventilated subject.

In one aspect, a subject with or suspected of having a neurological disorder via intranasal inhalation of an aerosol comprising pirfenidone or a pyridone analog for nasal vascular absorption and delivery to the central nervous system. A method for treating a neurological disease is described herein comprising administering pirfenidone or a pyridone analog to the nasal cavity of a patient, wherein the disease is multiple sclerosis. In some embodiments, the subject is confirmed to have multiple sclerosis. In some embodiments, the subject is a ventilated subject.

In one aspect, described herein are methods of administering pirfenidone or a pyridone analogue to treat a patient with idiopathic pulmonary fibrosis (IPF), wherein the patient, following administration of pirfenidone or a pyridone analogue, has liver avoiding liver function abnormalities indicated by Grade 2 or greater abnormalities after oral administration of one or more biomarkers of function, the method comprising administering to the patient pirfenidone or a pyridone analog at a dose of less than 300 mg per day; including the step of administering. In some embodiments, "Grade 2 liver function abnormalities" are greater than 2.5 times and less than or equal to 5 times the upper limit of normal (ULN), alanine transaminase (ALT), asparagine Including elevated acid transaminase (AST), alkaline phosphatase (ALP), or gamma glutamyltransferase (GGT). Grade 2 liver function abnormalities also include elevated bilirubin levels greater than 1.5 times and less than or equal to 3 times the ULN. In some embodiments, the pirfenidone or pyridone analog is delivered to the patient by oral or intranasal inhalation. In some embodiments, the one or more biomarkers of liver function are selected from the group consisting of alanine transaminase, aspartate transaminase, bilirubin, and alkaline phosphatase. In some embodiments, the method further comprises measuring one or more biomarkers of liver function. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is less than 10 mcg/mL. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is greater than 10 mcg/mL.

In one aspect, described herein are methods of administering pirfenidone or pyridone analogs to treat patients with idiopathic pulmonary fibrosis (IPF), wherein the patient has a photosensitivity reaction observed after oral administration. and the method comprises administering pirfenidone or a pyridone analogue to said patient at a dose of less than 360 mg per day. In some embodiments, the pirfenidone or pyridone analog is delivered to the patient by oral or intranasal inhalation. In some embodiments, the incidence of photosensitivity adverse events is less than about 12%. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is less than 10 mcg/mL. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is greater than 10 mcg/mL.

In one aspect, described herein are methods of administering pirfenidone or pyridone analogs to treat patients with idiopathic pulmonary fibrosis (IPF), wherein the patient avoids developing phototoxicity after oral administration. and the method comprises administering pirfenidone or a pyridone analog to said patient at a dosage of less than 360 mg per day. In some embodiments, the pirfenidone or pyridone analog is delivered to the patient by oral or intranasal inhalation. In some embodiments, the incidence of adverse events of photosensitivity reactions is less than about 12%. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is less than 10 mcg/mL. In some embodiments, the blood Cmax after administration of the pirfenidone or pyridone analog is greater than 10 mcg/mL.

In one aspect, a method of administering pirfenidone or a pyridone analog to treat a patient with idiopathic pulmonary fibrosis (IPF) by delivering the pirfenidone or pyridone analog directly to the lungs by oral or intranasal inhalation. is described herein, and patients avoid the occurrence of gastrointestinal adverse events after oral administration. In some embodiments, gastrointestinal adverse events observed following oral administration of pirfenidone or pyridone analogues include, but are not limited to, gastrointestinal upset, nausea, diarrhea, gastroesophageal reflux disease (GERD), and vomiting. or one or more. In some embodiments, less than 360 mg of pirfenidone or pyridone analog per day is delivered to the patient by inhalation. In some embodiments, less than 1000 mg, less than 900 mg, less than 600 mg, or less than 300 mg of pirfenidone or pyridone analog per day is delivered to the patient by inhalation. In some embodiments, less than 300 mg of pirfenidone or pyridone analog per day is delivered to the patient by inhalation per dose. In some embodiments, the pirfenidone or pyridone analog is delivered by inhalation once a day, twice a day, three times a day, or four times a day.

In some embodiments, up to about 360 mg of pirfenidone or pyridone analog is delivered to the patient by inhalation per dose. In some embodiments, about 1 mg to about 360 mg, about 10 mg to about 360 mg, about 20 mg to about 360 mg, about 30 mg to about 360 mg, about 40 mg to about 360 mg, about 50 mg to about 360 mg, about 60 mg to about 70 mg, about 80 mg to about 360 mg; Or the pyridone analogue is delivered to the patient by inhalation on a dose-by-dose basis. In some embodiments, the pirfenidone or pyridone analog is delivered by inhalation once a day, twice a day, three times a day, or four times a day.

In one aspect, pharmaceutical compositions are described herein comprising a therapeutically effective amount of an inhaled drug, wherein the drug is pirfenidone or a pyridone analogue, and the drug is aerodynamic mass Particles having a mean diameter of less than 5 microns or a volume mean diameter of less than 10 microns, the composition delivering a single dose of pirfenidone or pyridone analogue compound to the lungs of greater than 1 mcg per gram of pulmonary tissue in an adult human after inhalation. deliver.

In one aspect, described herein is a pharmaceutical composition for aerosol delivery to the lung comprising a solution of a pirfenidone or pyridone analogue containing a divalent cation. In some embodiments, divalent cations are selected from the group consisting of calcium, iron, magnesium, and beryllium. In some embodiments, the ratio of pirfenidone or pyridone analog to divalent cation is within a molar range of about 0.1-10:1, in unit increments of about 0.01. For example, 1: about 10, 1: about 9, 1: about 8, 1: about 7, 1: about 6, 1: about 5, 1: about 4, 1: about 3, 1: about 2, 1: about 1.5, 1: about 1, 1: about 0.75, 1: about 0.5, 1: about 0.25, 1: about 0.1. In some embodiments, the active pharmaceutical ingredient is a pirfenidone or pyridone analog and the concentration is between 0.1 mg/mL and 50 mg/mL in unit increments of composition of about 0.01 mg/mL. . For example, about 0.1 mg/mL, about 0.5 mg/mL, about 1 mg/mL, about 2 mg/mL, about 3 mg/mL, about 4 mg/mL, about 5 mg/mL, about 6 mg/mL, about 7 mg/mL , about 8 mg/mL, about 9 mg/mL, about 10 mg/mL, about 15 mg/mL, about 20 mg/mL, about 25 mg/mL, about 30 mg/mL, about 30 mg/mL, about 35 mg/mL, about 40 mg/mL , about 45 mg/mL, about 50 mg/mL, about 55 mg/mL, and about 60 mg/mL. In some embodiments, the active pharmaceutical ingredient is not a salt of a pirfenidone or pyridone analogue. In some embodiments, the composition is a stable, water-soluble formulation. In some embodiments, the osmolality is greater than about 50 mOsmol/kg of composition in unit increments of about 1 mOsmol/kg. For example, 50 mOsmol/kg, about 100 mOsmol/kg, about 150 mOsmol/kg, about 200 mOsmol/kg, about 250 mOsmol/kg, about 300 mOsmol/kg, about 350 mOsmol/kg, about 400 mOsmol/kg, about 450 mOsmol/kg, about 500 mOsmol/kg. , about 550 mOsmol/kg, about 600 mOsmol/kg, about 650 mOsmol/kg, about 700 mOsmol/kg, about 750 mOsmol/kg, about 800 mOsmol/kg, about 850 mOsmol/kg, about 900 mOsmol/kg, about 950 mOsmol/kg, about 1000 mOsmol/kg greater than about 1500 mOsmol/kg, about 2000 mOsmol/kg, greater than about 2500 mOsmol/kg, greater than about 3000 mOsmol/kg, about 3500 mOsmol/kg, about 4000 mOsmol/kg, greater than about 4500 mOsmol/kg, greater than about 5000 mOsmol /kg, about 5500 mOsmol/kg, about 6000 mOsmol/kg, or greater than about 6000 mOsmol/kg. In some embodiments, the pH is greater than about 3.0 in about 0.1 pH unit increments. For example, about 3 pH, about 3.5 pH, about 4 pH, about 4.5 pH, about 5 pH, about 5.5 pH, about 6 pH, about 6.5 pH, about 7 pH, about 7.5 pH, about 8 pH, about 8.5 pH, about 9 pH, about 9.5 pH, about 10 pH, about 10.5 pH and about 11 pH. In some embodiments, the pH is citric acid, citrate, malic acid, malate, pyridine, formic acid, formate, piperazine, succinic acid, succinate, histidine, maleic acid, bis-tris, pyroline an organic buffer selected from the group consisting of acid, phosphoric acid, phosphate, PIPES, ACES, MES, cacodylic acid, carbonic acid, carbonate, ADA (N-(2-acetamido)-2-iminodiacetic acid); Balanced by inclusion. In some embodiments, the pirfenidone or pyridone analog solution comprises a permeant ion concentration. In some embodiments, the permeating ion is selected from the group consisting of bromine, chloride and lithium. In some embodiments, the osmotic ion concentration is from about 30 mM to about 300 mM in increments of about 0.1 mM. For example, about 30 mM, about 40 mM, about 50 mM, about 60 mM, about 70 mM, about 80 mM, about 90 mM, about 100 mM, about 150 mM, about 200 mM, about 250 mM, and about 300 mM. In some embodiments, the composition further comprises a flavoring agent. In some embodiments, the flavoring agent is selected from the group consisting of lactose, sucrose, dextrose, saccharin, aspartame, sucralose, ascorbate, polyvalent cations and citrate. In some embodiments, the concentration of taste masking agent is from 0.01 mM to about 50 mM in increments of about 0.01 mM. For example, about 0.01 mM, about 0.05 mM, about 0.1 mM, about 0.2 mM, about 0.3 mM, about 0.4 mM, about 0.5 mM, about 0.6 mM, about 0.7 mM, about 0.05 mM. 8 mM, about 0.9 mM, about 1 mM, about 2 mM, about 3 mM, about 4 mM, about 5 mM, about 6 mM, about 7 mM, about 8 mM, about 9 mM, about 10 mM, about 15 mM, about 20 mM, about 25 mM, about 30 mM, about 35 mM, about 40 mM, about 45 mM, and about 50 mM.

In some embodiments, the formulations described herein are packaged into primary packages. In some embodiments, the primary packaging material is obtained from the group consisting of glass or plastic, wherein the plastic material consists of low density polyethylene (LDPE), high density polypropylene (HDPP), or high density polyethylene (HDPE). It may be selected from a group. In some embodiments, the primary package consists of a vial, syringe, or ampoule. In some embodiments, the composition is protected from light.

In some embodiments, the compositions described herein are formulated under hypoxic conditions or will result in hypoxic conditions. In some embodiments, oxygen is reduced by injecting a formulation diluent prior to addition of the active pharmaceutical ingredient. The injection gas may be selected from the group consisting of carbon dioxide, argon or nitrogen. In some embodiments, oxygen is reduced by injecting a formulation diluent after addition of the active pharmaceutical ingredient. The injection gas may be selected from the group consisting of carbon dioxide, argon or nitrogen.

In some embodiments, oxygen exposure is reduced by replacing the gas surrounding the upper space of the formulation container with an inert gas. The inert gas may be selected from the group consisting of argon or nitrogen.

In some embodiments, oxygen exposure is reduced by replacing the gas around the perimeter of the primary packaging container with an inert gas.

In some embodiments, oxygen exposure is reduced by inserting the primary package into a gas impermeable secondary package container. The inert gas may be selected from the group consisting of argon or nitrogen.

In some embodiments, an aerosol for delivery to the lungs of a mammal described herein comprises between 10-100% fine particles in 1% unit increments. For example, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, About 70%, about 75%, about 80%, about 85%, about 90%, about 95%, or about 100%. In some embodiments, the dose of fine granules is between about 0.1 mg and about 360 mg of pirfenidone or pyridone analog in 0.1 mg increments. For example, about 0.1 mg, about 0.5 mg, about 1 mg, about 2 mg, about 3 mg, about 4 mg, about 5 mg, about 6 mg, about 7 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 13 mg. , about 14 mg, about 15 mg, about 16 mg, about 17 mg, about 18 mg, about 19 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 150 mg, about 200 mg, about 220 mg, about 240 mg, about 260 mg, about 280 mg, about 300 mg, about 320 mg, about 340 mg, or about 360 mg.

In some embodiments, the composition further comprises a mucolytic agent suitable for pulmonary delivery. In some embodiments, the composition further comprises a second anti-fibrotic drug suitable for pulmonary delivery. In some embodiments, the composition further comprises a second anti-inflammatory agent suitable for pulmonary delivery.

These and other aspects of the invention will become apparent upon reference to the following detailed description. All U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications, and non-patent literature cited herein are incorporated as if each were individually incorporated. incorporated herein by Aspects of the invention can be modified, if necessary, to employ concepts of the various patents, applications and publications to provide further embodiments of the invention.

Figure 3 shows modeled nebulized aerosol administration of pirfenidone and oral administration of pirfenidone to human subjects. The model incorporates the scaled pharmacokinetics of Example 6. Modeled Nebulized Aerosol Administration to Humans—Target Lung Tissue Cmax of 50 mcg/gram and Related Lung Tissue and Plasma Pharmacokinetics. The model incorporates the scaled pharmacokinetics of Examples 6 and 7. Hydroxyproline results from the bleomycin model of pulmonary fibrosis. A U-shaped dose response of pirfenidone is demonstrated. We also show that low-dose, direct pulmonary aerosol delivery enables the antifibrotic effects of pirfenidone within the limits of an AUC-dependent U-shaped dose response. Delta values for hydroxyproline were obtained by first subtracting the sham results and then subtracting the value from the bleomycin only control. p-values obtained: #=0.012 (same lung Cmax), *=0.084 (same lung Cmax), and *=0.075 (same plasma AUC); a. Trivdei et al, Nanotechnology. 23(50):505101, 2012. A histologic examination (fibrosis score) results from the bleomycin model of pulmonary fibrosis. A U-shaped dose response of pirfenidone is demonstrated. We also show that low-dose, direct pulmonary aerosol delivery enables the antifibrotic effects of pirfenidone within the limits of an AUC-dependent U-shaped dose response. A delta value for the fibrosis score was obtained by first subtracting the sham results and then subtracting the value from the bleomycin only control. p-values obtained: #=0.007 (same lung Cmax), *=0.042 (same lung Cmax), and *=0.143 (same plasma AUC); Modeled human inhaled aerosol pirfenidone pharmacokinetics. We demonstrate that aerosol inhalation enables a broad pirfenidone therapeutic window within the limits of pirfenidone's U-shaped dose response. The model incorporates the scaled pharmacokinetics of Example 8. Inhalation provides a broad therapeutic window within the limits of pirfenidone's U-shaped dose response. An 801 mg oral pirfenidone dose (taken with food; Rubino et al., Pulm Pharmacol Ther. 22(4):279-85, 2009), 120 mg pirfenidone RDD inhaled over 5 minutes produced comparable plasma AUC and 50 mg pirfenidone RDD inhaled over 5 minutes resulted in 2.4 times lower plasma AUC and 18 times greater lung tissue Cmax; and A 2.5 mg pirfenidone RDD inhaled over 1 minute results in a 50-fold lower plasma AUC and an equivalent lung tissue Cmax. The top panel inset shows pirfenidone pharmacokinetics between 0-10 mcg/gram of human lung tissue and 0-4 hours.

many undesirable pulmonary diseases such as interstitial lung disease (ILD and subclasses thereof), chronic obstructive pulmonary disease (COPD and subclasses thereof), asthma, and The manifestations of pulmonary, renal, cardiac and ocular fibrosis are initiated by external stress. By way of non-limiting examples, these effectors may include infection, smoking, environmental exposure, radiation exposure, surgical procedures and transplant rejection. However, it can also be attributed to other causes related to genetics and the effects of aging.

In the epithelium, scars play a valuable healing role after injury. However, epithelial tissue can become scarred over time after chronic and/or repeated injury, resulting in functional abnormalities. In idiopathic pulmonary fibrosis (IPF and other subclasses of ILD), damage to a significant proportion of the lung can lead to respiratory failure. In any event, progressive scarring may result from a series of recurrent injuries to different areas of the organ or from the inability to halt the healing process after the injury has healed. In such cases, the scarring process becomes uncontrolled and unregulated. In some forms of fibrosis, scarring remains localized to a limited area, but can affect more diffuse and widespread areas, resulting in direct or associated organ failure.

In neurological diseases, inflammatory destruction of myelin (demyelination) is considered the primary event in diseases such as multiple sclerosis. Demyelination causes scarring and hardening (sclerosis) of nerve tissue in the spinal cord, brain and optic nerve. Demyelination slows the conduction of nerve impulses, resulting in weakness, numbness, pain and loss of vision.

In epithelial injury, epithelial cells release the potent fibroblast growth factor transforming growth factor-beta (TGF-beta), tumor necrosis factor (TNF), endothelins, cytokines, metalloproteinases, and the coagulation mediator tissue factor. triggering the release of multiple profibrotic mediators, including factor). Importantly, the epithelial cells that caused the release become vulnerable to apoptosis, possibly coupled with the inability to restore the epithelial cell layer, the most fundamental abnormality in fibrotic diseases. In the case of demyelination, abnormal TNF expression or activity is considered an underlying cause of other neurological diseases such as multiple sclerosis and rheumatic diseases.

Pro-inflammatory and pro-fibrotic use of pyridone analogues such as pirfenidone in diseases such as pulmonary fibrosis, renal fibrosis, cardiac fibrosis and ocular fibrosis, multiple sclerosis and rheumatic diseases Physiological responses characterized by control of sex factors may be beneficial in attenuating and/or reversing fibrosis and demyelination. Therapeutic strategies that take advantage of the effects of pyridone analogs and/or pirfenidone as described above in these and other indications are extensively discussed herein.

TNF-alpha is expressed in asthmatic airways and may play an important role in amplifying asthmatic inflammation through activation of NF-kappaB, AP-1 and other transcription factors. Activation of IgE receptors causes the release of TNF-alpha from human lung tissue and upregulates TNF mRNA levels in eosinophils. TNF-alpha causes a transient bronchial hyperreactivity, presumably through a response mediated by expression of muscarinic receptors.

TNF-alpha is also believed to play a central role in the pathophysiology of COPD. It is produced by alveolar macrophages, neutrophils, T cells, mast cells and epithelial cells after contact with various pollutants, including cigarette smoke. TNF-alpha has been shown to induce COPD-associated pathological features such as inflammatory cell infiltration into the lung, pulmonary fibrosis and emphysema in animal models. Interestingly, the level of TNF-alpha in sputum increases significantly during acute exacerbations of COPD.

The mechanism of action of analogues of pyridone such as pirfenidone is believed to be anti-inflammatory and anti-fibrotic. Pirfenidone inhibits the synthesis and release of proinflammatory cytokines and reduces inflammatory cell accumulation in response to various stimuli. Pirfenidone also stimulates fibroblast proliferation, production of fibrosis-associated proteins and cytokines, and extracellular matrix biosynthesis and accumulation in response to cytokine growth factors such as TGF-beta and platelet-derived growth factor (PDGF). moderate the increase in

In an in vitro cell-based assay, pirfenidone inhibited fibroblast proliferation and induced lipopolysaccharide (LPS)-stimulated release of PDGF, tumor necrosis factor-alpha (TNF-alpha), and TGF-beta1. inhibited collagen synthesis. Depending on assay conditions, these in vitro activities were evident at pirfenidone concentrations from about 30 microM to about 10 mM (from about 5.5 mcg/mL to about 1.85 mg/mL). Given that the oral Cmax of pirfenidone in IPF patients is from about 42 micron M in the recommended fed state to about 84 micron M in the fasted state (or about 7.9 mcg/mL to about 15.7 mcg/mL, respectively) , these same activities may also be enhanced in vivo, albeit to a narrower extent of observed efficacy.

Oral administration of pirfenidone to LPS-challenged mice reduced dose-dependent mortality, decreased blood levels of the proinflammatory cytokines TNF-alpha, interleukin (IL-12), and interferon gamma, and It resulted in increased blood levels of the anti-inflammatory cytokine, IL-10. Treatment with pirfenidone prevented LPS-associated hemorrhagic necrosis and apoptosis in the liver and reduced the increase in TGFbeta.

In vitro studies suggest that pirfenidone may also reduce fibrogenesis through selective inhibition of p38 mitogen-activated protein kinase (MAPK). These observations were associated with a decrease in collagen synthesis induced by TGFbeta. A parallel observation that turning off p38 may restore sensitivity to corticosteroids in COPD holds promise for this and other disease populations. Unfortunately, compounds that inhibit p38 MAPK have also been found to be toxic and have been withdrawn from clinical practice. Each of these compounds has been used for oral administration.

In rat, hamster and mouse models of bleomycin-induced pulmonary fibrosis, prophylactic administration of pirfenidone reduced pulmonary fibrosis as assessed by both histopathological analysis and quantitative determination of collagen content. rice field. Treatment with pirfenidone also reduced pulmonary edema and decreased pulmonary levels of TGFbeta, basic fibroblast growth factor (bFGF), and various pro-inflammatory cytokines.

In rats, pirfenidone reduced collagen production and deposition in liver fibrosis, reversed cardiac and renal fibrosis, and, without normalizing myocardial contractility or renal function, from animals treated with streptozotocin. attenuated the increase in diastolic stiffness of the diabetic heart. In DOCA-salt hypertensive rats, pirfenidone also reversed and prevented cardiac remodeling and attenuated and prevented increased cardiac stiffness without reducing the increased vascular response to noradrenaline.

Human studies have demonstrated clinical anti-inflammatory and anti-fibrotic benefits of oral pirfenidone. Test values for phototoxicity, gastrointestinal disturbances and abnormal liver function may also appear in human populations after oral administration of pirfenidone. As a result, patient medication must be closely monitored. Phase 3 clinical studies with orally administered pirfenidone required an initial dose escalation to establish gastrointestinal tolerance. However, the incidence of nausea, rash, gastrointestinal disturbances, dizziness, vomiting, photosensitivity reactions, anorexia, and elevated AST and ALT serum transaminase levels limited dosage levels during and after escalation. be done. In some cases, oral administration of pirfenidone may result in dose reduction or discontinuation of pirfenidone administration.

In addition to the dose escalation of pirfenidone required to establish gastrointestinal tolerance, failure to achieve tolerance would otherwise be removed from therapy (e.g., up to 50% and less than 50%). Dose reduction and the use of food have been employed to allow oral administration to individuals. In addition, clinical studies utilizing food usage to allow for dose tolerance may also be attempted. In both cases plasma Cmax decreases in a dose-proportional manner. More specifically, the fed state results in an approximately 50% reduction in Cmax, an approximately 7-fold increase in Tmax, and a 10-15% reduction in overall exposure. Both fed and fasted conditions resulted in a plasma half-life of approximately 2.5 hours. While this approach may also reduce gastrointestinal-related adverse events, the lack of clinically significant efficacy in recent orally administered clinical studies may have been affected by these techniques. .

Based on clinical observations and adverse events as well as observed toxicities, oral pirfenidone therapy is limited to doses of about 1800 mg/day to about 2400 mg/day (600 mg TID to 801 mg TID, respectively). Thus, while pirfenidone has demonstrated broad non-human efficacy, adverse events and toxicity in humans have limited oral administration to the lower end of this range.

A regulatory risk-benefit analysis between the observed efficacy of orally administered pirfenidone and associated adverse events was performed in a terminally ill population with unmet clinical need. Even these have raised concerns that these doses do not provide sufficient efficacy to warrant safety risks. In certain embodiments, administration of an equivalent or increased pirfenidone or pyridone analog dose directly to the disease site (e.g., into the lungs) would provide comparable efficacy or improved efficacy over the oral route. Provided herein are methods for inhalation delivery of In certain embodiments, these doses require less drug to be administered. In certain embodiments, this approach of administering pirfenidone by inhalation may benefit from reduced systemic exposure and an increased safety margin compared to oral administration of pirfenidone. Described herein are compositions of pirfenidone or pyridone analog compounds suitable for delivery to a mammal by inhalation, and methods of using such compositions.

It is not clear from the existing data whether the pirfenidone anti-inflammatory or anti-fibrotic mechanism of action is driven by Cmax or exposure (area under the curve, AUC). In some embodiments, low to moderate observed clinical efficacy is about 5 mcg/mL or pirfenidone plasma levels greater than 5 mcg/mL, about 50 mg·hr/L or 50 mg·hr/L exposure (AUC _0-infinity ) and/or a plasma clearance rate of about 2.5 hours.

In some embodiments, intravenous or oral administration of pirfenidone results in lung epithelial lining fluid (ELF) levels comparable to those observed in plasma; A clinically measured plasma Cmax of about 5 mcg/mL or greater than 5 mcg/mL is directly related to the observed low to moderate clinical pulmonary efficacy. In some embodiments, plasma levels of pirfenidone from oral administration are associated with low efficacy, and thus, in some embodiments, resulting ELF and lung tissue levels are also associated with low efficacy. In other embodiments, intravenous or oral administration of pirfenidone may result in lung epithelial laminar fluid (ELF) levels below those observed to be effective from plasma. In some embodiments, ELF levels consistent with effective levels observed in plasma delivered orally or intravenously may be from 0.1 mcg/mL to about 5 mcg/mL. In some embodiments, ELF levels consistent with effective levels observed in plasma may be from 0.1 mcg/mL to about 1 mcg/mL. In some embodiments, ELF levels consistent with effective levels observed in plasma delivered orally or intravenously may be from 0.5 mcg/mL to about 5 mcg/mL. In some embodiments, ELF levels consistent with effective levels observed in plasma delivered orally or intravenously may be from 0.3 mcg/mL to about 3 mcg/mL. In some embodiments, administration of pirfenidone directly to the lung results in delivery of about 5 mcg, or greater than about 5 mcg, of pirfenidone per 1 mL of ELF, and is observed at administration. Equivalent pulmonary efficacy may result without increased systemic levels associated with adverse events and toxicities. By way of non-limiting example, this is accomplished by oral or intranasal inhalation delivery of an aerosolized pirfenidone or pyridone analogue to the lungs with a concentration of about 0.1 mcg/mL or greater than about 0.1 mcg/mL. also many, e.g. /mL, 6 mcg/mL, 7 mcg/mL, 8 mcg/mL, 9 mcg/mL, or greater than 10 mcg/mL of pirfenidone or pyridone analogue to ELF. Once in the ELF, the pirfenidone or pyridone analogue, in some embodiments, penetrates lung tissue, resulting in about 0.004 mcg to 0.7 mcg of pirfenidone or pyridone analogue (about From about 0.1 mcg/mL in 25 mL ELF to about 5 mcg/mL in about 75 mL ELF, approximately 600 grams of adult lung tissue weight).

In some embodiments, pirfenidone may readily equilibrate between plasma and lungs and/or between other organs. In some embodiments, organ pirfenidone levels may also mimic plasma levels, eg, lung, heart, kidney, or nervous system. In some embodiments, delivering about 0.004 mcg, or 0.004 mcg to 0.7 mcg of pirfenidone per gram of tissue may provide similar therapeutic effects to other organs. . In some embodiments, giving additional pirfenidone or pyridone analogs may provide additional efficacy. In some embodiments, this may be accomplished by inhalation (ie, oral or intranasal inhalation) delivery of an aerosolized pirfenidone or pyridone analogue to the lungs. In some embodiments, pirfenidone or pyridone analogs delivered to the lung are readily available to the heart. In some embodiments, about 0.1 mcg/mL to about 5 mcg/mL of ELF is provided; alternatively, 0.004 mcg/gram or about 0.7 mcg/gram of lung tissue pirfenidone or pyridone analog is provided to ELF. Alternatively, pirfenidone or pyridone analogs at 0.2-0.7 mcg/gram of pulmonary tissue showed similar effects on the heart without the increased systemic adverse events or toxicities observed with oral administration. may result in effective administration of In some embodiments, delivery of aerosolized pirfenidone or pyridone analogs to the lungs by intranasal or oral inhalation may result in effective delivery of pirfenidone or pyridone analogs to the liver. In some embodiments, the pirfenidone or pyridone analog delivered to the lung becomes available to the liver. In some embodiments, about 0.1 mcg/mL to about 5 mcg/mL of ELF, or about 0.004 mcg/gram to about 0.7 mcg/gram of lung tissue pirfenidone or pyridone analog. may provide similar effective administration to the liver without the increased systemic adverse events or toxicity observed with oral administration. In some embodiments, delivery of aerosolized pirfenidone or pyridone analogs to the lungs by intranasal or oral inhalation may result in effective delivery of pirfenidone or pyridone analogs to the kidneys. In some embodiments, the pirfenidone or pyridone analog delivered to the lung becomes available to the kidney. In some embodiments, about 0.1 mcg/mL to about 5 mcg/mL of ELF, or about 0.004 mcg/gram to about 0.7 mcg/gram of lung tissue pirfenidone or pyridone analog. may provide similar effective dosing to the kidney without the increased systemic adverse events or toxicity observed with oral dosing. In some embodiments, intranasal inhalation delivery of an aerosolized pirfenidone or pyridone analog to the nasal cavity may result in effective delivery of the pirfenidone or pyridone analog to the central nervous system (CNS). In some embodiments, nasal inhalation delivery of pirfenidone or pyridone analogs is readily available to the CNS. In some embodiments, about 0.1 mcg/mL to about 5 mcg/mL of ELF or about 0.004 mcg/gram to about 0.7 mcg/gram of lung tissue pirfenidone or pyridone analog equivalent administered intranasally Giving a dose as low as 0.01% may result in similarly effective administration to the CNS without the increased systemic adverse events or toxicity observed with oral administration.

In some embodiments, topical delivery of an aerosolized liquid or cream of pirfenidone or pyridone analog to the desired site of effect to provide a tissue weight of from about 0.004 mcg/gram to about 0.7 mcg/gram, It may result in similarly effective dosing without systemic adverse events or toxicity. In some embodiments, topical delivery of an aerosolized liquid or cream pirfenidone or pyridone analog to damaged skin epithelia prevents scarring, fibrosis, and/or inflammation, or It can also be reversed. This damage can be the result of infection, burns, surgery, acute or chronic injury (such as bedsores), or other event. In some embodiments, topical delivery of liquid or dry powder pirfenidone or pyridone analogs to the bladder is associated with scarring, fibrosis, and/or bladder infections, bladder cancer, indwelling catheters, or other events. It may also prevent inflammation. In some embodiments, topical delivery of liquid pirfenidone or pyridone analogs to the eye may prevent the development of post-operative fibrosis in the conjunctiva and/or episclera after glaucoma surgery.

In some embodiments, infusion delivery of liquid pirfenidone or pyridone analogs to the desired site of effect provides about 0.004 mcg/gram to about 0.7 mcg/gram of tissue weight pirfenidone or pyridone analogs. results in similarly effective dosing without the associated side effects or toxicity. In some embodiments, infusion delivery of liquid pirfenidone or pyridone analogs to skeletal joints is effective in treating scarring, fibrosis, and/or autoimmune diseases, arthritis, rheumatoid arthritis, infections, or other events. May prevent associated inflammation.

In some embodiments, in addition to Cmax, and even in additional embodiments, pirfenidone exposure (AUC) to the disease site may be essential for efficacy. In some embodiments, a plasma AUC _0-infinity of about 50 mg·hr/L or greater than or equal to 50 mg·hr/L is also associated with pulmonary efficacy. In some embodiments, the partial or complete equilibration of pirfenidone between plasma and lung ELF and between plasma and lung tissue may give an AUC that can also be mimicked in the lung. In other embodiments, the lung ELF and tissue AUC may be less.

In some embodiments, AUC and/or half-life, individually or in combination Cmax, are required for efficacy; therefore, in some embodiments, all three parameters required for efficacy (Cmax, AUC , and half-life) are provided. In some embodiments, by way of non-limiting example, provide an ELF AUC _0-infinity of about 1.0 mg·hr/L or about 50 mg·hr/L and are delivered via an oral route Direct inhalation delivery of about 0.1 mcg to about 5 mcg of pirfenidone or pyridone analogs into 1 mL of lung ELF is equally effective, maintaining these values over the same period of time. Similarly, in other embodiments, direct inhalation delivery of 1 gram of about 0.2004 mcg or 0.2004 mcg to 0.7 mcg of pirfenidone or a pyridone analog to lung tissue results in plasma AUC ₀ after oral delivery _- providing an AUC 0-infinity for tissues less than _{infinity to an AUC 0-infinity for} tissues equal to or approximately equal to it, and in a further embodiment, at the same time when delivered via the oral route; Maintaining these values for a while is equally effective. In some embodiments, the following assumptions and theoretical calculations are stated for inhalation therapy:

ELF Delivery Assumptions:
1. The total volume of human ELF is 25 mL.
2. The inhaled route of administration depends on the respirable delivery dose (RDD), which is the portion of the drug inhaled in aerosol particles less than 5 microns in diameter.
3. The RDD of a typical dry powder, liquid nebulization, or metered dose device varies from 10% to 70%. In some embodiments, high efficiency or resistivity devices with RDD greater than 70% and less than 10% are contemplated.
4. The plasma pirfenidone or pyridone analog half-life after oral administration is approximately 2.5 hours. In some embodiments, intestinal absorption influences this vule, but for typical purposes of this model, pirfenidone half-life in pulmonary ELF after inhalation delivery is halved after oral administration. (eg 2.5 hours/2=1.25 hours). The half-life values may be supported by measurements showing that intravenous administration of pirfenidone results in an approximately halved lung ELF half-life after oral administration.
5. In some embodiments, a lung ELF level of 5 mcg/mL may be the lower limit of efficacy. as well as,
6.801 mg oral pirfenidone produces plasma levels (human measurements) of 5 mcg/mL or greater than 5 mcg/mL over 4 hours. For route comparison purposes, this model assumes that ELF pirfenidone levels after oral administration remain at or about 5 mcg/mL lung ELF for the same duration as plasma.

A typical ELF calculation:
Mcg pirfenidone delivered to 25 mL ELF = 125 mcg to make 1.5 mcg/mL
Based on an RDD efficiency of 2.30%, the required unit dose is 416 mcg (125 mcg/0.3=416 mcg).
Based on an RDD efficiency of 3.50%, the required unit dose is 250 mcg (125 mcg/0.5=250 mcg).
Based on an RDD efficiency of 4.70%, the required unit dose is 179mcg (125mcg/0.7=179mcg).
Correct to maintain at or above these values for 3.2 half-lives of 1.25 hours each (5 mcg/mL or 5 mcg/mL or greater with a lung half-life of 1.25 hours). 4 hours = 3.2 half-lives)
For a 5.30% RDD efficiency, the unit dose required to maintain the lower clinically observed efficacy limit (416 mcg in this case) for 3.2 half-lives is 3994 mcg.
For an RDD efficiency of 6.50%, the unit dose required to maintain the lower clinically observed efficacy limit (250 mcg in this case) for 3.2 half-lives is 2400 mcg.
For an RDD efficiency of 7.70%, the unit dose required to maintain the lower clinically observed efficacy limit (179 mcg in this case) for 3.2 half-lives is 1718 mcg.

By way of non-limiting example, and based on the above assumptions, and in certain embodiments, a dose of about 4 mg in a device delivering pirfenidone or pyridone analogs with an efficiency of 30% is equivalent to 801 mg. It may also result in pulmonary ELF levels of 5 mcg/mL or greater over the same time period as obtained after oral administration. Furthermore, while the minimally effective pirfenidone dosage may be maintained over this duration, local pirfenidone levels may also exhibit significantly higher ELF Cmax levels conferring improved efficacy. In some embodiments, delivery of 4 mg of pirfenidone or pyridone analog using a 30% efficiency device is about 48 mcg/mL (4 mg X 30% = 1.2 mg. 1.2 mg/25 mL ELF = 48 mcg/mL). may result in a lung ELF Cmax of up to In some embodiments, based on the above assumptions, a dose of approximately 66 mg in a device administering pirfenidone or pyridone analogs with an efficiency of 70% is 1.85 mg/mL (66 mg X 70% = 46. 2 mg. 46.2 mg/25 mL ELF = 1.85 mg/mL) may result in lung ELF Cmax. In some embodiments, based on the above assumptions, a dose of approximately 154 mg in a device administering pirfenidone or pyridone analogs with an efficiency of 30% is 1.85 mg/mL (154 mg X 30% = 46. 2 mg. 46.2 mg/25 mL ELF = 1.85 mg/mL) may result in lung ELF Cmax. In some embodiments, based on the above assumptions, a dose of approximately 12 mg in a device administering pirfenidone or pyridone analogs with an efficiency of 70% is 336 mcg/mL (12 mg X 70% = 8.4 mg. It may result in lung ELF Cmax up to 8.4 mg/25 mL ELF=336 mcg/mL). In some embodiments, based on the above assumptions, a dose of approximately 28 mg in a device administering pirfenidone or pyridone analogs with an efficiency of 30% is also 336 mcg/mL (28 mg X 30% = 8.4 mg. It may result in lung ELF Cmax up to 8.4 mg/25 mL ELF=336 mcg/mL). In some embodiments, this dosage may maintain a minimal effective dose at 5 mcg/mL or greater than or equal to 5 mcg/mL for about 6 half-lives or about 15 hours. In some embodiments, the embodiments described for inhalation therapy provide beneficial efficacy by increasing Cmax, 5 mcg/mL or Maintain drug exposure at a minimal effective range of greater than 5 mcg/mL. In some embodiments, long-term exposure allows for reduced dosing intervals (e.g., once daily or twice daily versus the current three times daily oral dosing regimen). good too. In some embodiments, these doses may result in significantly lower systemic plasma levels (eg, about 2 mcg/mL of pirfenidone), while delivery is direct to the lungs. In some embodiments, about 28 mg of pirfenidone or pyridone analog delivered using an aerosol device with an efficiency of 30% results in levels in the vasculature and tissues immediately downstream of the lungs (or nasal cavity) initially As a result, the systemic plasma dilution concentration may be approximately 1.7 mcg/mL (28 mg X 30% = 8.4 mg; 8.4 mg/5 L of systemic blood = 1.7 mcg/mL). In some embodiments, delivery of about 46 mg of pirfenidone or pyridone analog may result in a systemic plasma diluent concentration of about 9.3 mcg/mL.

Those skilled in the art will recognize from the discussion herein that if the actual measured lung ELF half-life of pirfenidone or pyridone analog elimination changes, the dose calculated in the above model will change. deaf. The shorter the half-life, the more pirfenidone or pyridone analogues would need to be administered to maintain lung ELF concentrations above what is considered a minimally effective level. A further increase in the administered pirfenidone or pyridone analog may be desirable to further improve efficacy. Furthermore, in addition to delivering the desired lung tissue Cmax and AUC, delivery of aerosol pirfenidone or pyridone analogs by oral or intranasal inhalation may also serve as an efficient route for systemic delivery. . In some embodiments, inhalation delivery of pirfenidone or pyridone analogs contemplates a dosing scheme that can achieve the desired lung tissue Cmax and AUC, which have a slower plasma half-life than lung ELF, and a specific plasma concentration of Targeted delivery may in turn prolong pulmonary ELF-pirfenidone or pyridone analog exposure.

Typical pulmonary tissue delivery assumptions:
1. The total wet weight of an adult lung is approximately 685-1,050 grams (approximately 1,000 grams is conservative for calculation purposes).
2. The pulmonary blood volume of an adult is approximately 450 mL.
3. Adult lung tissue weight is conservatively equal to 600 grams, which is 1,050 grams wet weight minus 450 mL blood weight (assuming a density of 1.0).
4. In some embodiments, after injecting mice with pirfenidone intravenously,
- Plasma pirfenidone Tmax is comparable to lung Tmax.
An intravenous administration of −40 mg/kg produces a plasma Cmax of approximately 55 mcg/mL and a lung Cmax of 30 mcg/gram wet weight.
- Conservatively, blood makes up about 40% of the wet weight of the lungs. In some embodiments, given that plasma and lung Tmax are comparable, it follows that most of the 30 mcg/g pirfenidone measured in wet lung is due to the presence of blood. Conservatively, if blood constitutes about 40% of the wet weight of the lungs, then 40% of the plasma Cmax (or 40% of 55 mcg/mL X) of about 22 mcg/gram pirfenidone in the measured lung weight is It is due to Taking the difference between wet lung Cmax and this number (or 30 mcg/g minus 22 mcg/g), there is about 8 mcg/g in lung tissue.
- A measured wet lung half-life that is about 45% longer than the plasma half-life may be considered. Taking the argument that about 40% or more of wet lung pirfenidone is in blood, the actual lung tissue half-life is 45% longer than plasma.
From the above observations and calculations that a plasma Cmax of 5.55 mcg/mL yields a lung tissue Cmax of about 8 mcg/gram, the following comparisons to humans can be made.
- According to initial assumptions, the lower limit of human efficacy is 5 mcg/mL plasma pirfenidone.
- 5mcg/mL divided by 55mcg/mL is about 9.1%, assuming the above ratio (55mcg/mL plasma results in 8mcg/gram of lung tissue) also applies to humans. .
9.1% of 8mcg/gram is about 0.7mcg/gram.
- Taken together, 5 mcg/mL plasma pirfenidone may result in 0.7 mcg/gram lung tissue pirfenidone. Therefore, about 0.7 mcg/gram of lung tissue pirfenidone is the lower limit of efficacy.
6. The inhalation route of administration depends on the respirable delivered dose (RDD). RDDs are the fraction of drugs inhaled in aerosol particles less than 5 microns in diameter.
7. Typical dry powder, liquid nebulization, or metered dose inhaler RDDs vary from 10% to 70%. There are also high and low efficiency devices with RDD greater than 70% and less than 10%.
8. As discussed above, the lung tissue pirfenidone half-life is much longer (2-4 times, or even 2-4 times more) than the plasma pirfenidone half-life delivered intravenously. Plasma pirfenidone half-life after oral administration is approximately 2.5 hours. However, continued intestinal absorption affects this number and is therefore much longer than after intravenous delivery. Therefore, for the purposes of this model, pulmonary tissue pirfenidone half-life after inhalation delivery is assumed to be comparable to that after oral administration (eg, 2.5 hours).
9. From the above observations and calculations, the lower limit of efficacy in lung tissue is 8 mcg/gram.
Combining 10.801 mg oral pirfenidone to produce human plasma levels of 5 mcg/mL or greater over 4 hours and 5 mcg/mL plasma to produce 0.7 mcg/gram lung tissue pirfenidone, What is delivered by intranasal inhalation must be 0.7 mcg/gram or more pulmonary tissue pirfenidone for at least 4 hours for equivalent pulmonary fibrosis efficacy to oral administration.

Typical lung tissue calculation:
1. Mcg pirfenidone delivered to 1000 grams of wet lung tissue (blood plus lung tissue) = 700 mcg to make 0.7 mcg/gram.
Based on an RDD efficiency of 2.30%, the required unit dose is 2,333 mcg (700 mcg/0.3=2,333 mcg).
Based on an RDD efficiency of 3.50%, the required unit dose is 1,400 mcg (700 mcg/0.5=1,400 mcg).
Based on an RDD efficiency of 4.70%, the required unit dose is 1,000 mcg (700 mcg/0.7=1,000 mcg). Correct to maintain at or above these values for two half-lives of 2.5 hours each (0.7 mcg/gram or greater with a lung half-life of 2.5 hours). 4 hours in wet lung tissue = 1.6 half-lives)
For an RDD efficiency of 5.30%, the unit dose required to meet the clinically observed lower bound of oral route efficacy (2,333 mcg in this case) for 1.6 half-lives is 3,733 mcg.
For an RDD efficiency of 6.50%, the unit dose required to meet the clinically observed lower bound of oral route efficacy (1,400 mcg in this case) for 1.6 half-lives is 2,240 mcg.
For an RDD efficiency of 7.70%, the unit dose required to meet the clinically observed lower bound of oral route efficacy (1,000 mcg in this case) for 1.6 half-lives is 1,600 mcg.

By way of non-limiting example, based on the above assumptions, a dose of approximately 3.7 mg in a device delivering pirfenidone or pyridone analogues with an efficiency of 30% is the same as obtained after an oral dose of 801 mg. It may also result in wet lung tissue levels of 0.7 mcg/gram or more over a sustained period. Furthermore, although the minimal effective dose of pirfenidone is maintained for this duration, local pirfenidone levels may exhibit significantly higher wet lung tissue Cmax levels that provide improved efficacy. By way of non-limiting example, delivery of 3.7 mg of pirfenidone or pyridone analogs using a device with 30% efficiency is approximately 1.1 mcg/gram (3.7 mg X 30% = 1.1 mg.1. It may result in a wet lung tissue Cmax of up to 1 mg/1,050 grams of wet lung weight = 1.1 mcg/gram). This number is nearly 1.5 times higher than the number delivered after oral delivery. By way of another non-limiting example, based on the above assumptions, a dose of approximately 50 mg in a device delivering pirfenidone or pyridone analogs with 30% efficiency would be 14.3 mcg/mL (50 mg X 30% = 15 mg. /1,050 grams wet lung weight = 14.3 mcg/gram), or approximately 20 times higher lung tissue Cmax when delivered after oral delivery. In this scenario, this dose provides a minimum effective dose of 0.7 mcg/gram for at least about 5 half-lives, or about 12.5 hours, compared to 4 hours after administration of the 801 mg oral dose. It may result in maintenance with moist lung tissue or more. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 15 mg in a device delivering pirfenidone or pyridone analogs with 70% efficiency would be 10 mcg/mL (15 mg X 70% = 10.5 mg. Wet lung tissue Cmax of up to 10.5 mg/1,050 grams of wet lung weight = 10 mcg/gram), or approximately 14 times higher lung tissue Cmax when delivered after oral delivery. In this scenario, this dose has a minimum effective dose of 0.7 mcg/gram over a period of about 4.5 half-lives, or at least about 11 hours, compared to 4 hours after administration of an oral dose of 801 mg. It may result in maintenance with moist lung tissue or more. Such durations exceeding 0.7 mcg/gram of lung tissue may permit twice daily (BID) dosing. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 75 mg in a device delivering pirfenidone or pyridone analogs with 70% efficiency would be 50 mcg/mL (75 mg X 70% = 52.5 mg 52.5 mg/1,050 grams wet lung weight = 50 mcg/gram), or approximately 71 times higher lung tissue C max when delivered after oral delivery. In this scenario, this dose provides a minimum effective dose of 0.7 mcg/gram wet lung for at least about 6 half-lives, or over about 15 hours, compared to 4 hours after administration of the 801 mg oral dose. It may result in maintenance in the organization or even more. Such duration exceeding 0.7 mcg/gram of lung tissue may permit BID administration. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 15 mg in a device delivering pirfenidone or pyridone analogs with 30% efficiency would be 4.3 mcg/mL (15 mg X 30% = 4 .5 mg (4.5 mg/1,050 grams of wet lung weight = 4.3 mcg/gram), or approximately 6 times higher lung tissue C max when delivered after oral delivery. There is also In this scenario, this dose provides a minimum effective dose of 0.7 mcg/gram for at least about 3 half-lives, or about 7.5 hours, compared to 4 hours after administration of the 801 mg oral dose. It may result in maintenance with moist lung tissue or more. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 75 mg in a device delivering pirfenidone or pyridone analogs with 30% efficiency would be 21 mcg/mL (75 mg X 30% = 22.5 mg 22.5 mg/1,050 grams wet lung weight = 21 mcg/gram), or approximately 31 times higher lung tissue C max when delivered after oral delivery. In this scenario, this dose provides a minimum effective dose of 0.7 mcg/gram for at least about 5 half-lives, or about 12.5 hours, compared to 4 hours after administration of the 801 mg oral dose. It may result in maintenance with moist lung tissue or more. Such duration exceeding 0.7 mcg/gram of lung tissue may permit BID administration. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 15 mg in a device delivering pirfenidone or pyridone analogs with 10% efficiency would be 1.4 mcg/mL (15 mg X 10% = 1 .5 mg (1.5 mg/1,050 grams wet lung weight = 1.4 mcg/gram), or approximately twice as high lung tissue C max when delivered after oral delivery. There is also In this scenario, this dose reduces the minimum effective dose to 0.7 mcg/gram over about 1 half-life, or at least about 2.5 hours, compared to 4 hours after administration of the 801 mg oral dose. It may result in maintenance with moist lung tissue or more. Similarly, by way of another non-limiting example, based on the above assumptions, a dose of approximately 75 mg in a device delivering pirfenidone or pyridone analogs with 10% efficiency would be 7.1 mcg/mL (75 mg X 10% = 7 .5 mg (7.5 mg/1,050 grams of wet lung weight = 7.1 mcg/gram), or approximately twice as high when delivered after oral delivery. There is also In this scenario, this dose reduces the minimum effective dose to 0.7 mcg over about 3.5 half-lives, or at least about 8.8 hours, compared to 4 hours after administration of the 801 mg oral dose. /gram of wet lung tissue or higher may result. Such duration exceeding 0.7 mcg/gram of lung tissue may permit TID administration. Such an approach increases Cmax and maintains drug exposure with a minimal effective range of wet lung tissue of 0.7 mcg/gram or greater for longer durations than are currently limited by oral administration. This can benefit effectiveness. Such long-term exposure may allow for shorter dosing intervals (eg, once daily or twice daily as opposed to the current three times daily oral dosing regimen). Furthermore, while this approach delivers directly to the lungs, using the non-limiting example above, systemic plasma levels are reduced (e.g., 0.6 mcg from a delivered dose of 4.5 mg into 5000 mL of blood). Cmax) from less than pirfenidone/mL to less than 2 mcg/mL pirfenidone from a delivered dose of 15 mg to less than 10 mcg/mL pirfenidone from a dose of 75 mg.

Variations in the actual measured lung tissue half-life of pirfenidone or pyridone analog elimination would significantly alter the dose calculated by the above model. With a faster half-life, more and more inhaled pirfenidone or pyridone analogs would be required to maintain lung tissue concentrations above what would be considered the minimum effective level. Further increases in inhaled pirfenidone or pyridone analogues may be desirable to further improve efficacy. Furthermore, in addition to delivering desirable lung tissue Cmax and AUC, inhalation delivery of aerosol pirfenidone or pyridone analogs may serve as an efficient route for systemic delivery. In some embodiments, to first achieve the desired lung tissue Cmax and AUC, dosing schemes are contemplated that allow for inhaled delivery of pirfenidone or pyridone analogs, where the plasma half-life is less than the lung tissue half-life. Therefore, targeting the delivery of specific plasma concentrations may in turn prolong exposure of pirfenidone or pyridone analogues to pulmonary tissue.

Because scarring is irreversible, the efficacy of IPF is its action to protect native lung tissue from aggressive fibrosis. Therefore, maintaining normal levels of effective drugs in unaffected tissues is essential to improving patient survival. Clinical and nonclinical studies suggest that the efficacy of pirfenidone is dose-responsive, ranging from improvement to improvement in weakened disease. Unfortunately, significant gastrointestinal (GI) side effects and systemic toxicity force approved oral doses at the lower end of this range. Complicating matters is the recommendation of dose-absorbing foods and the frequent initiation of dose reduction/discontinuation procedures that address these tissues, further reducing the dose to the lungs. and the necessary maintenance therapy of this otherwise promising drug is discontinued. Direct inhalation delivery of aerosol pirfenidone or pyridone analogs to the lung reduces or eliminates these safety or tolerability limitations associated with the oral route of delivery.

The efficacy of oral pirfenidone has been substantiated in human clinical studies to some extent, and data suggest that this effect increases with higher doses. Unfortunately, severe side effects and toxicities limited the oral dosage at the lower end of this efficacy range (Esbriet was approved up to 2403 mg/d). Esbriet's formulation threatened this already low effective dose and therefore included an initial dose escalation scheme and dosing with the recommended food to achieve minimal GI tolerance and an acceptable side effect/toxicity profile. required (up to 3 capsules of 267 mg or 801 mg three times daily (TID)). Unfortunately, not all patients reach this recommended dose, and food reduces bioavailability (food reduces Cmax and AUC by ˜50% and ˜20%, respectively). In addition, increased liver enzyme levels and cutaneous photoreactivity initiate a physician-directed dose reduction and discontinuation procedure. This procedure was allowed to 50% dose reduction before discontinuation in Phase 3 trials (in these studies, between 48% and 67% of patients had dose reductions). Since long-term pulmonary tissue administration of efficacious drug concentrations is essential to maintain protection from invasive fibrosis, the prescription and practice of oral pirfenidone should be considered effective for this otherwise promising drug. likely to result in sub-effective dosing (a hypothesis that partially explains the moderate efficacy observed in the Phase 3 trial).

For oral administration in the context of pulmonary fibrosis treatment, high oral doses are required to achieve the plasma levels required for effective lung tissue exposure. However, gastrointestinal side effects and systemic toxicity have limited the approved oral doses to levels that limit efficacy and the lower end of the dose-response curve. In one embodiment, the inhaled pirfenidone or pyridone analog improves the efficacy of treatment with pirfenidone by increasing pulmonary dose and improving compliance. In one embodiment, inhalation of the pirfenidone or pyridone analog (eg, using a nebulizer) delivers the pirfenidone or pyridone analog directly to the lungs, minimizing systemic distribution of the delivered dose. . In some embodiments, inhalation of pirfenidone reduces or eliminates GI exposure and/or systemic toxicity common to oral administration of pirfenidone or pyridone analogs. In some embodiments, inhalation delivery of pirfenidone or pyridone analogs provided herein provides higher lung tissue levels of pirfenidone than would be possible through oral administration. In some embodiments, inhalation delivery of pirfenidone or pyridone analogs serves as an efficient means of delivering pirfenidone or pyridone analogs to systemic compartments. In some embodiments, inhaled delivery of pirfenidone or pyridone analogs provides Cmax and AUC advantages over the oral route. In some embodiments, inhalation delivery of pirfenidone or pyridone analogs provides Cmax and AUC advantages over the oral route, and plasma-recirculated, aerosol-delivered pirfenidone or pyridone analogs provide these Maintain beneficial properties. In some embodiments, the methods described herein may be used to treat patients diagnosed with mild to moderate IPF. In some embodiments, the methods described herein may be used to treat patients diagnosed with mild to severe IPF. In some embodiments, the methods described herein may be used to treat a patient diagnosed with mild to moderate IPF without first needing to escalate the patient's dosage. In some embodiments, the methods described herein may be used to treat a patient diagnosed with mild to severe IPF without first needing to escalate the patient's dosage. In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or liver enzyme-related adverse events. It may not be necessary and may be used to treat patients diagnosed with mild to moderate IPF. In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or liver enzyme-related adverse events. It may not be necessary and may be used to treat patients diagnosed with mild to severe IPF. In some embodiments, the methods described herein may be used to administer prophylactic treatment to patients diagnosed with mild to moderate IPF. In some embodiments, the methods described herein may be used to administer prophylactic treatment to patients diagnosed with mild to severe IPF. In some embodiments, the methods described herein may be used to administer prophylactic treatment to a patient with mild to moderate IPF without first needing to escalate the patient's dosage. In some embodiments, the methods described herein provide prophylactic treatment to patients diagnosed with mild to severe IPF without first requiring the patient to be dosed. In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or liver enzyme-related adverse events. Without need, it may be used to administer prophylactic treatment to patients diagnosed with mild to moderate IPF. In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or liver enzyme-related adverse events. Without need, it may be used to administer prophylactic treatment to patients diagnosed with mild to severe IPF. In some embodiments, the methods described herein may be used to slow disease progression in patients diagnosed with mild to moderate IPF without requiring the patient to be dosed initially. good. In some embodiments, the methods described herein may be used to slow disease progression in patients diagnosed with mild-to-severe IPF without first requiring the patient to be dosed up. . In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or hepatic enzyme-related adverse events. It may not be necessary and may be used to slow disease progression in patients diagnosed with mild to moderate IPF. In some embodiments, the methods described herein monitor treatment, reduce dosage, or discontinue treatment for gastrointestinal, phototoxic, or hepatic enzyme-related adverse events. It may not be necessary and may be used to slow disease progression in patients diagnosed with mild to severe IPF. By way of non-limiting example, clinical endpoints of IPF efficacy are reduced reduction in forced vital capacity (FVC), reduced reduction in distance walked in 6-minute intervals (6-minute walk test; 6MWT), carbon monoxide Includes gradual reduction in diffusion capacity (DL _CO ), improved progression-free survival (PFS), reduced mortality, and monitoring changes in biomarkers such as MMP7 and CCL18. A comparison of oral and inhaled aerosol properties that may be observed in some embodiments is shown in Table A.

In some embodiments, the methods described herein provide delivery of high concentrations of a readily bioavailable pirfenidone or pyridone analog compound that slowly dissolves or otherwise dissolves. It provides improved efficacy over pirfenidone or pyridone analog compounds administered by the oral route or by inhalation of an otherwise slowly bioavailable compound formulation. In some embodiments, such slowly dissolving or otherwise slowly bioavailable compound formulations for inhalation include, but are not limited to, dry powder formulations, liposomal formulations, nano Including suspension formulations or microsuspension formulations. In some embodiments, the aqueous solutions of pirfenidone or pyridone analogs described and contemplated herein for administration by inhalation are completely homogeneous and soluble.

In some embodiments, a barrier to patient compliance with oral pirfenidone therapy is GI intolerance. Pirfenidone blood levels may also be important as they have been implicated in other observed toxicities. Therefore, factors contributing to increased blood levels must be considered. For the oral route of administration, toxicity and GI intolerance limited the dose to 801 mg three times daily. Elevations of liver enzymes, photosensitivity reactions, and phototoxicity occur at this dose, but are more frequent and severe at higher doses. Second, pirfenidone is metabolized primarily by CYP1A2. In vitro metabolism studies using liver microsomes show that approximately 48% of pirfenidone is metabolized by CYP1A2, with other CYP isoenzymes including CYP2C9, 2C19, 2D6, and 2E1 each contributing less than 13%. indicates Thus, inhibition of these enzyme systems results in elevated pirfenidone blood levels, resulting in increased incidence and severity of toxicity. To achieve this goal, items such as grapefruit juice, fluvoxamine, and other inhibitors of CYP1A2 should be avoided during oral treatment with pirfenidone.

Oral pirfenidone is contraindicated in patients taking concomitant fluvoxamine. Fluvoxamine must be discontinued prior to initiation of Esbriet therapy and avoided during Esbriet therapy due to reduced clearance of pirfenidone. Other therapies that are inhibitors of both CYP1A2 and one or more other CYP isoenzymes involved in pirfenidone metabolism (eg, CYP2C9, 2C19 and 2D6) should also be avoided during pirfenidone treatment.

Similarly for oral administration, CYP1A2 inhibitors are involved in the metabolism of pirfenidone such as CYP2C9 (e.g. amiodarone, fluconazole), 2C19 (e.g. chloramphenicol), and 2D6 (e.g. fluoxetine, paroxetine). Particular caution must be exercised when used in combination with potent inhibitors of one or more other CYP isozymes.

Oral products should be used with caution in patients being treated with other mild or strong inhibitors of CYP1A2 (eg ciprofloxacin, amiodarone, propafenone).

Since many products that provide CYP enzymes are useful to fibrotic patients, it is beneficial to allow their use. While the oral route is already at maximally tolerated doses (which provide only modest efficacy), any inhibition of the enzymes described above will raise pirfenidone blood levels and reduce the rate of toxic events described herein. hastens and worsens severity. In some embodiments, oral and intranasal inhalation delivery of pirfenidone or pyridone analogs can achieve effective tissue levels with far less drug than is required by oral drug products; Some embodiments result in significantly lower blood levels, excluding results associated with the CYP enzyme inhibitory properties described herein. In some embodiments, the use of those CYP inhibitor enzyme products that are currently contraindicated for use with oral medications may be administered with analogs of pirfenidone or pyridone.

The primary metabolite of pirfenidone is 5-carboxy-pirfenidone. After oral or intravenous administration, this metabolite appears readily in high blood concentrations. 5-Carboxy-pirfenidone does not appear to have anti-fibrotic or anti-inflammatory effects, and its high blood levels result from decreased pirfenidone blood levels. Thus, while oral products are administered at the highest possible blood levels, once pirfenidone enters the blood, pirfenidone is rapidly metabolized to its inactive species, further requiring considerable efficacy. Reduce drugs that may achieve adequate lung levels. In some embodiments, oral and intranasal inhalation delivery of pirfenidone or pyridone analogs can directly achieve efficacious lung tissue levels, thus minimizing extrapulmonary metabolism.

In some embodiments, administration of the pirfenidone or pyridone analog compound by inhalation reduces gastrointestinal side effects compared to oral administration. In some embodiments, the reduced gastrointestinal side effects of administration by inhalation obviate the need for initial dose escalation. In some embodiments, administration of pirfenidone or pyridone analogs by inhalation avoids or substantially avoids the gastrointestinal tract, thus the effects observed with oral administration of pirfenidone or pyridone analog compounds are: Minimized or non-existent. In some embodiments, the lack of food effect on administration by inhalation allows delivery of the total dose.

In some embodiments, the pharmaceutical compositions described herein are used in treating pulmonary disease in mammals. In some embodiments, the pharmaceutical compositions described herein are administered to a mammal by the method of oral or intranasal inhalation to treat pulmonary disease in the mammal. In some embodiments, the pulmonary disease includes, but is not limited to, asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, idiopathic pulmonary fibrosis, radiation-induced fibrosis, silicosis, asbestos-induced fibrosis associated with acute pulmonary or pleural fibrosis, acute lung injury, acute respiratory distress syndrome (ARDS), sarcoidosis, common interstitial pneumonia (UIP), cystic fibrosis, chronic lymphocytic leukemia (CLL) disease, Hamman-Rich syndrome, Kaplan syndrome, coal workers' pneumoconiosis, fibrous alveolitis of unknown cause, bronchiolitis obliterans, chronic bronchitis, emphysema, interstitial pneumonia, Wegner's granulomatosis, pulmonary scleroderma silicosis, interstitial lung disease, asbestos-induced pulmonary fibrosis and/or pleural fibrosis. In some embodiments, the lung disease is pulmonary fibrosis (ie, pulmonary fibrosis). In some embodiments, the lung disease is idiopathic pulmonary fibrosis.

(pulmonary fibrosis)
In some embodiments, the compositions and methods described herein can treat, slow progression of, or prevent pulmonary fibrosis. In some embodiments, pulmonary fibrosis comprises interstitial pulmonary fibrosis. This group of disorders is characterized by deep lung tissue scarring, leading to shortness of breath and lack of functional alveoli, thus limiting oxygen exchange. Etiologies include inhalation of inorganic and organic powders, gases, fumes, and vapors, drug use, exposure to radiation, and the development of disorders such as hypersensitivity pneumonitis, coal-miners' pneumoconiosis, radiation, chemical Including therapy, transplant rejection, silicosis, pneumothorax, and genetic factors.

IPF, as described herein, refers to "idiopathic pulmonary fibrosis," which in some embodiments is a chronic disease that manifests over years and is characterized by scar tissue within the lungs with no known triggers. there is Exercise-induced shortness of breath and chronic dry cough may be prominent symptoms. IPF belongs to a family of pulmonary disorders known as interstitial lung disease (ILD) or, more precisely, diffuse parenchymal lung disease. Within this broad category of diffuse lung disease, IPF belongs to a subgroup known as idiopathic interstitial pneumonia (IIP). There are seven characteristic IIPs distinguished by specific clinical features and pathological patterns. IPF is the most common form of IIP. IPF is associated with a pathological pattern known as common interstitial pneumonia (UIP). Therefore, IPF is often called IPF/UIP. IPF is usually fatal, with median survival of approximately 3 years from the time of diagnosis. There is no single test for diagnosing pulmonary fibrosis, and several different tests can be used with the methods described herein, including chest radiographs, pulmonary function tests, exercise tests, bronchoscopies, and lung biopsies. be done.

Idiopathic pulmonary fibrosis (also known as fibrous alveolitis of unknown cause) is the most common form of interstitial lung disease and is characterized by chronic progressive parenchymal fibrosis of the lung. Sometimes. Idiopathic pulmonary fibrosis is a progressive clinical syndrome with unknown etiology, and the prognosis is often fatal because no effective treatment exists. In some embodiments, pirfenidone inhibits fibroblast proliferation and differentiation associated with collagen synthesis, inhibits TGFbeta production and activity, reduces fibronectiv and connective tissue growth factor production, reduces TNFalpha and Inhibits I-CAM, increases IL-10 production, and/or reduces platelet-derived growth factor (PDGF) A and B levels in bleomycin-induced pulmonary fibrosis. The pirfenidone methods and compositions described herein may be well tolerated and useful in patients with severe idiopathic pulmonary fibrosis and other pulmonary diseases. In some embodiments, the pirfenidone methods and compositions described herein may be tolerated and useful in patients with mild to moderate idiopathic pulmonary fibrosis. In some embodiments, increased patient survival, enhanced vital capacity, decreased acute exacerbation episodes (compared to placebo), and/or delayed disease progression were observed with pirfenidone treatment following be done.

In some embodiments, inhaled delivery of pirfenidone or pyridone analogs may be an effective means to prevent, manage, or treat idiopathic pulmonary fibrosis or other pulmonary fibrosis diseases. The term "pulmonary fibrosis" includes all interstitial lung diseases associated with fibrosis. In some embodiments, pulmonary fibrosis includes the terms "idiopathic pulmonary fibrosis" or "IPF." In some embodiments, pulmonary fibrosis is associated with, by non-limiting examples, inhalation of inorganic and organic powders, gases, fumes and vapors, use of drugs, exposure to radiation or radiation therapy, and , the development of disorders such as hypersensitivity pneumonitis, coal workers' pneumoconiosis, radiation, chemotherapy, transplant rejection, silicosis, colic lung disease, and genetic factors.

Exemplary pulmonary diseases to be treated or prevented using the methods described herein include, but are not limited to, idiopathic pulmonary fibrosis, pulmonary fibrosis secondary to systemic inflammatory diseases such as rheumatoid arthritis, scleroderma lupus, unexplained fibrotic alveolitis, radiation-induced fibrosis, chronic obstructive pulmonary disease (COPD), sarcoidosis, scleroderma, chronic asthma, silicosis, asbestos-induced pulmonary fibrosis pneumonia or pleural fibrosis, acute lung injury and acute respiratory distress syndrome (bacterial pneumonia-induced, trauma-induced, viral pneumonia-induced, ventilator-induced, non-pulmonary sepsis-induced (including those induced by aspiration).

(renal fibrosis)
In some embodiments, the compositions and methods described herein can treat, slow progression of, or prevent renal fibrosis. Renal fibrosis can also develop as a result of chronic infections, ureteral obstruction by stones, malignant hypertension, radiation therapy, transplant rejection, severe diabetic conditions, or long-term exposure to heavy metals. In addition, idiopathic glomerulosclerosis and renal interstitial fibrosis have been reported in children and adults. Renal fibrosis is often associated with an overall decline in renal function. Studies have shown that oral pirfenidone provides protective effects against reversal of heavy metal challenge and fibrosis after induction of diabetes in rats. Furthermore, an antifibrotic effect of pirfenidone in renal fibrosis after partial nephrectomy in rats was also demonstrated. In addition, clinical studies with oral pirfenidone showed delayed decline in renal function in patients with focal segmental glomerulosclerosis. In some embodiments, since the renal blood vessels are immediately downstream of the lungs, delivery of pirfenidone or pyridone analogs by inhalation exposes systemic compartments to otherwise harmful drugs associated with oral administration. However, it may be an effective means to prevent, manage, or treat renal fibrosis resulting from various medical conditions or procedures.

The term "renal fibrosis" includes, by non-limiting examples, chronic infections, ureteral obstruction by stones, malignant hypertension, radiation therapy, transplant rejection, severe diabetic conditions, or long-term exposure to heavy metals. Remodeling related to exposure for a period of time, or consequent on these.

<Cardiac and renal toxicity>
In some embodiments, the compositions and methods described herein can treat, slow the progression of, or prevent cardiac and/or renal toxicity. Chemotherapeutic agents have toxicity to multiple organs during treatment. By way of non-limiting example, doxorubicin has a broad spectrum of therapeutic activity against various tumors. However, its clinical use is limited by its undesired systemic toxicity, especially in the heart and kidney. Treatment with pirfenidone reduced the severity of doxorubicin-induced toxicity as assessed by reduced mortality, decreased the amount of fluid recovered in the peritoneal cavity, and reduced the amount of fluid recovered at the biochemical and morphological levels. Reduced severity of cardiac and renal lesions. In some embodiments, since the vasculature of the heart and kidney is immediately downstream of the lungs, inhaled delivery of pirfenidone or pyridone analogs may leave the systemic compartment free from other toxic effects associated with oral administration. It can be an effective means of preventing, managing or treating chemotherapy-induced cardiac and/or renal inflammation without exposure to drug concentrations. In some embodiments, delivery of pirfenidone or pyridone analog compounds by inhalation is used to treat cardiotoxicity and/or renal toxicity associated with chemotherapeutic agents or other therapeutic agents in humans.

By way of non-limiting example, the term "cardiotoxicity" can be related to or caused by exposure to a toxic chemotherapeutic agent. By way of non-limiting example, doxorubicin has a broad spectrum of therapeutic activity against various tumors. However, its clinical use is limited by its undesirable systemic toxicity, especially in the heart and kidney.

By way of non-limiting example, the term "renal toxicity" can be related to or caused by exposure to a toxic chemotherapeutic agent. By way of non-limiting example, doxorubicin has a broad spectrum of therapeutic activity against various tumors. However, its clinical use is limited by its undesirable systemic toxicity, especially in the heart and kidney.

<Cardiac fibrosis>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent cardiac fibrosis. Cardiac remodeling, as in chronic hypertension, is associated with myocyte hypertrophy and fibrosis, increased and non-identical deposition of extracellular matrix proteins. The extracellular matrix connects muscle cells, arranges contractile elements, prevents muscle cell overextension and destruction, transmits forces, and provides tensile strength to prevent tearing. Fibrosis occurs in many models of hypertension leading to increased diastolic stiffness, decreased cardiac function and increased risk of arrhythmias. Given that fibrosis, rather than myocyte hypertrophy, is a significant factor in impaired cardiovascular function, reversal of cardiac fibrosis itself may return cardiac function to normal. Since collagen deposition is a dynamic process, an appropriate drug load selectively reverses existing fibrosis and prevents further fibrosis, thereby improving function even though increased systolic blood pressure remains unchanged. obtain.

Treatment of DOCA-salt hypertensive rats with pirfenidone reversed and prevented fibrosis. It has been suggested that pirfenidone or pyridone analog therapy may also be an effective means of reducing cardiac dysfunction in humans with cardiac fibrosis and hypertension associated with chronic hypertension. In addition, reversal of fibrosis following pirfenidone treatment of streptozotocin-diabetic rats was also shown (Miric et al., 2001). In summary, since the cardiovascular vasculature is immediately downstream of the lungs, delivery of pirfenidone or pyridone analogues by inhalation is recommended for, by non-limiting examples, viral or bacterial infections, surgery, Duchenne muscular dystrophy, radiation, chemotherapy. , and transplant rejection.

By way of non-limiting example, the term "cardiac fibrosis" involves viral or bacterial infection, surgery, Duchenne muscular dystrophy, radiation therapy, chemotherapy, transplant rejection, and muscle cell hypertrophy and fibrosis, and extracellular It relates to remodeling associated with or resulting from chronic hypertension, resulting in increased non-identical deposition of matrix proteins. Fibrosis occurs in many models of hypertension leading to increased diastolic stiffness, decreased cardiac function, increased risk of arrhythmias and impaired cardiovascular function.

<Liver fibrosis>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent liver fibrosis. Liver fibrosis results from severe liver damage in patients with chronic liver disease caused by non-limiting examples of persistent viral hepatitis, alcohol overdose and autoimmune diseases. Liver fibrosis is associated with abnormal accumulation of extracellular matrix components, particularly collagen. Hepatic stellate cells are nonparenchymal hepatocytes present in the perisinusoidal space. These cells have been shown to be the major cellular source of extracellular matrix in liver fibrosis. Oral pirfenidone reduced dimethylnitrosamine-induced liver fibrosis in preventing weight loss, inhibiting liver weight loss, inhibiting the induction of liver fibrosis as measured by histological evaluation, and reducing hepatic hydroxyproline levels. Studies have shown that it provides a protective effect against disease. Expression of mRNA for type I collagen and transforming growth factor beta in liver was also suppressed by pirfenidone treatment. Moreover, clinical studies administering oral pirfenidone have shown decreased fibrosis and improved quality of life in patients with hepatitis C virus-associated liver disease. Taken together, these results suggest that inhaled delivery of pirfenidone or pyridone analogues exposes systemic compartments to other toxic drug concentrations associated with oral administration because the hepatic vasculature is immediately downstream of the lungs. , can be an effective means to prevent, manage, or treat liver fibrosis resulting from a variety of medical conditions or procedures.

The term "liver fibrosis" by non-limiting examples can relate to severe liver damage in patients with chronic liver disease caused by persistent viral hepatitis, alcohol overdose and autoimmune diseases, or can be caused by it. Liver fibrosis is associated with abnormal accumulation of extracellular matrix components, particularly collagen. Hepatic stellate cells are nonparenchymal hepatocytes present in the perisinusoidal space.

<Multiple sclerosis>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent multiple sclerosis. Multiple sclerosis is a demyelinating disease characterized by neurological deficits resulting from demyelinating lesions in the white matter and progressive axonal loss. Evidence that TNF-alpha plays an important role in the pathogenesis of multiple sclerosis has led to the evaluation of pirfenidone in this indication. In clinical studies, oral pirfenidone improved Scripps Neurological Rating Scale scores over placebo. Furthermore, pirfenidone was associated with reduced relapses and marked improvement in bladder dysfunction. In summary, because the central nervous system vasculature is immediately downstream of the lungs, delivery of pirfenidone or pyridone analogues by inhalation is effective without exposing systemic compartments to other toxic drug concentrations associated with oral administration. These studies suggest that it may be an effective means to prevent, manage or treat multiple sclerosis.

The term "multiple sclerosis" is a demyelinating disease characterized by neurological deficits resulting from demyelinating lesions in the white matter and progressive axonal loss.

<Chronic obstructive pulmonary disease (COPD)>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent COPD. By way of non-limiting example, oxidative agents and stress caused by cigarette smoking are mediated at least in part by activation of the transcription factors nuclear factor (NF)-κB and activating protein (AP)-1. promote disease. They regulate the expression of several genes thought to be important in COPD, such as interleukin (IL)-8 and TNFα. These pro-inflammatory cytokines and chemokines are mitogen-activated proteins, a family of signaling enzymes that also include extracellular signal-regulated kinases (ERKs) and c-jun NH2-terminal kinases (JNKs), along with IL-1β. It strongly activates the p38 subgroup of kinases (MAPK). Members of JNK and p38 are activated primarily by cytokines involved in inflammation and apoptosis. Within the MAPK family, both the JNK and p38 subgroups are involved in mediating pro-inflammatory responses, although p38 appears to play a prominent role in COPD. Pirfenidone has been shown to inhibit both TNF alpha and p38-gamma MAPK. Furthermore, silencing of p38-gamma MAPK has been demonstrated to have the potential to restore COPD sensitivity to corticosteroids (Mercado et al., 2007). In some embodiments, delivery of pirfenidone or pyridone analog compounds by inhalation is used to treat COPD in humans. In some embodiments, inhalational delivery of pirfenidone or pyridone analogs prevents or manages COPD or related ailments without exposing systemic compartments to other toxic drug concentrations associated with oral administration. or may be an effective means to treat. Additionally, delivery of pirfenidone or pyridone analogues by inhalation may serve as a conjunctive therapy with corticosteroids to restore their usefulness in this indication.

The term “chronic obstructive pulmonary disease” or “COPD” by way of non-limiting example can be related to or caused by exposure to tobacco smoke and pre-existing asthma. COPD represents a wide range of airway diseases ranging from simple chronic bronchitis (cough due to excessive smoking) to more severe chronic obstructive bronchitis. When episodes of airway hyperreactivity are added to the above syndrome, the diagnosis of chronic asthmatic bronchitis is established. Chronic obstructive pulmonary disease includes, but is not limited to, chronic bronchitis, emphysema, and/or pulmonary hypertension.

<Asthma>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent asthma. TNF-alpha has been shown to be a highly pro-inflammatory cytokine in asthma as it upregulates adhesion molecules, increases mucin secretion and promotes airway remodeling. TNF-alpha is provided by a large number of cells in the airways, including mast cells, smooth muscle cells, epithelial cells, monocytes, and macrophages. This cytokine has been shown to be associated with and elevated in asthmatic patients. Clinical studies using anti-TNF-alpha therapy have yielded encouraging results. In a series of studies using a soluble form of the recombinant human TNF-alpha receptor (etanercept), the drug improved FEV1 and improved quality of life. Another clinical study administering anti-TNF-alpha antibodies reduced asthma exacerbations (infliximab). However, future studies of these treatments in asthma are unlikely because of problems related to adverse events. Since pirfenidone was shown to inhibit TNF-alpha, delivery by inhalation of pirfenidone or pyridone analogues could reduce asthma or related diseases without exposing systemic compartments to other toxic drug concentrations associated with oral administration. It can be an effective means to manage or treat. In some embodiments, inhalational delivery of a pirfenidone or pyridone analog compound is used to treat asthma in humans. In addition, delivery of pirfenidone or pyridone analogues by inhalation may serve as conjugative therapy with corticosteroids to restore their usefulness in steroid-resistant asthmatics.

The term "asthma" is associated with or caused by environmental and genetic factors. Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurrent pathology, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. The term asthma may be used with one or more adjectives to indicate cause. Non-limiting examples of asthma include, but are not limited to, allergic asthma, non-allergic asthma, acute severe asthma, chronic asthma, clinical asthma, nocturnal asthma, neutrophilic asthma, allergen-induced asthma, aspirin-sensitive asthma, exercise-induced asthma. asthma, childhood-onset asthma, adult-onset asthma, cough-type asthma, occupational asthma, steroid-resistant asthma, or seasonal asthma.

<Pulmonary inflammation>
In some embodiments, the compositions and methods described herein can treat or slow progression of or prevent pulmonary inflammation. Pirfenidone treatment was shown to have anti-inflammatory effects in addition to anti-fibrotic effects. In some embodiments, a pirfenidone or pyridone analog compound is administered to a human to treat pulmonary inflammation. Pulmonary inflammation is associated with or contributes to symptoms of bronchitis, asthma, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease.

<Fibrosis after glaucoma surgery>
The success of glaucoma filtration surgery depends on the extent of postoperative wound healing and the amount of scar tissue formation. Bleb effacement occurs when fibroblasts proliferate and migrate into the wound, ultimately causing scarring and closure of the fistula tract. This often leads to poor postoperative intraocular pressure control with subsequent progressive optic nerve damage. The use of adjunctive antifibrotic agents such as 5-fluorouracil and mitomycin C significantly improved the success rate of filtration surgery. However, due to their non-specific mechanisms of action, these agents can cause extensive cell death and apoptosis, resulting in severe postoperative hypotension, bleb leaks, and potentially vision-threatening complications such as endophthalmitis. Therefore, alternative anti-fibrotic agents are needed. For this purpose, the antifibrotic agents pirfenidone or analogues of pyridone may prove beneficial.

<Cancer>
Lung cancer mortality is high, with annual lung cancer deaths equal to cancers of the prostate, breast, colon, and rectum combined. Despite advances in knowledge of molecular mechanisms and the introduction of many new therapeutic lung cancer agents, the dismal 5-year survival rate (11-15%) remains relatively unchanged. This reflects the limited available knowledge about the factors that promote neoplastic transformation and proliferation of malignant cells.

Until recently, the main focus of cancer research has almost always been the malignant cells themselves. As a result, today there is a significant discrepancy between the vast knowledge about cancer biology that arises in the experimental setting and the translation of this knowledge into information that can be used in medical judgment. Understanding the nature of today's tumor environment can be as important for future cancer treatments as understanding cancer genetics itself. Cancers are composed not only of autonomous tumor cells, but of fibroblasts, immune cells, endothelial cells, and specific mesenchymal cells. These different cell types in the stromal environment can be recruited by malignant cells to support tumor growth and promote metastatic dissemination.

Although the "seed and soil" hypothesis was put forward more than a century ago, we now know that there is a complex relationship between tumor cells ("seed") and the tumor growth microenvironment ("soil"). I'm starting to understand the crosstalk. We now understand that tumor growth is not solely determined by malignant cells, as the interaction between cancer cells and the stromal compartment has a major impact on cancer growth and progression. Active malignant cells excel at exploiting the intratumoral microenvironment: tumor cells (1) settle in and transform the stroma, (2) alter the surrounding connective tissue, and (3) resident cells. metabolism, resulting in a non-defensive but permissive stroma.

Beyond overcoming host microenvironmental control, an important characteristic of cancer cells is their ability to invade tissues and metastasize away. For invasion and metastasis, concerted interactions between fibroblasts, immune cells and angiogenic cells and factors are essential.

The tumor stroma is essentially composed of (1) CAFs, specific mesenchymal cell types unique to each tissue environment, innate and adaptive immune cells, and vasculature with endothelial and pericytes. It consists of the non-malignant cells of the tumor and (2) the extracellular matrix (ECM), which consists of structural proteins (collagen and elastin), specific proteins (fibrillin, fibronectin, and elastin), and proteoglycans. Angiogenesis is central to cancer cell proliferation and survival and has been the most successful stromal target in anticancer therapy to date. Initiation of angiogenesis requires matrix metalloproteinase (MMP) induction, which leads to degradation of the basement membrane, endothelial cell sprouting, and regulation of pericyte adhesion. However, CAFs mediate these events through the expression of numerous ECM molecules and growth factors, including transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF), and fibroblast growth factor (FGF2). Plays an important role in tuning.

The stroma of normal tissue contains numerous cells that are essential for the maintenance and integrity of epithelial tissue and work together to sustain normal tissue homeostasis. There is a continuous and bilateral molecular crosstalk between canonical epithelium cells and cells of the stromal compartment, either through direct cell-cell adhesion or mediated by secreted molecules. Therefore, small changes in one compartment can cause dramatic changes in the whole system.

Since both entities have active angiogenesis and large numbers of proliferating fibroblasts, all of which are on a background of fibrin deposition, which secrete a complex ECM, similarities can be drawn between It exists between the tissue and the tumor. Consequently, tumor stroma has been commonly referred to as activated or reactive stroma.

The ongoing genetic modification of cancer leading to malignant cells consequently alters the host compartment of the stroma to establish a permissive and supportive environment for cancer cells. During the early stages of tumor growth and invasion, the basement membrane is degraded and the activated stroma, containing fibroblasts, inflammatory infiltrating cells, and newly formed capillaries, comes into direct contact with tumor cells. The basement membrane matrix also modifies cytokine interactions between cancer cells and fibroblasts. These cancer-induced changes in the stroma contribute to cancer invasion. Animal studies have shown that both wounded and activated stroma provide tumorigenic signals that promote tumorigenesis. Normal stroma in most organs contains a minimal number of fibroblasts associated with physiological ECM, whereas activated stroma is associated with more ECM-producing fibroblasts and blood vessels. Enhanced distribution and increased ECM production. This formation of specific tumor stroma types at sites of active tumor cell invasion is considered an essential part of tumor invasion and has been termed tumor stromatogenesis.

Expansion of tumor stroma by proliferation of fibroblasts and dense deposition of ECM is referred to as connective tissue formation response. It accompanies malignant proliferation and can be isolated from the alveolar recession showing neither activated fibroblasts nor dense collagen/ECM. Morphologically, this is termed connective tissue hyperplasia and was first viewed as a defense mechanism to prevent tumor growth, but data suggest that in established tumors this process, to a large extent, reverses angiogenesis. have been shown to be involved in various aspects of tumor progression, such as , migration, invasion, and metastasis. Later studies show that fibroblasts and tumor cells can enhance local tissue proliferation and cancer progression by secreting ECM and depleting ECM components within the tumor stroma. This is partly related to the release of substances sequestered in the ECM, such as VEGF, and the cleavage of products from ECM proteins in response to secretion of carcinoma-associated MMPs.

Profibrotic growth factors released by cancer cells, such as TGF-β, platelet-derived growth factor (PDGF), and FGF2, are all major mediators of fibroblast activation and tissue fibrosis. thus governs the amount and composition of the tumor stroma. PDGF and FGF2 play similar significant roles in angiogenesis.

In tumors, activated fibroblasts are termed peritumoral fibroblasts or carcinoma-associated fibroblasts (CAF). CAFs, such as activated fibroblasts, are highly heterogeneous and are thought to derive from the same source as activated fibroblasts. The main progenitors appear to be locally resident fibroblasts, but they also form pericytes and smooth muscle cells from the vasculature, mesenchymal cells from bone marrow, or epithelial or endothelial cells. may be derived from the metastasis of the mesenchyme of the The term CAF is rather ambiguous because of the different origins from which these cells are derived, as is the difference between activated fibroblasts and CAF. There is increasing evidence for epigenetic and possibly genetic differences between CAF and canonical fibroblasts. CAFs can be recognized by the expression of α-smooth muscle actin, but due to heterogeneity, α-smooth muscle actin expression alone does not distinguish all CAFs. Therefore, other CAF markers used are fibroblast-specific protein 1, fibroblast activation protein (FAP), and PDGF receptor (PDGFR) α/β.

In response to tumor growth, fibroblasts are activated primarily by chemokines such as TGF-β, monocyte chemoattractant protein 1, and ECM degrading agents such as MMPs. Standard fibroblasts in various in vitro studies have demonstrated an inhibitory effect on cancer progression, and today there is strong evidence demonstrating the cancer-promoting role of CAFs. In breast carcinoma, 80% of stromal fibroblasts are thought to have this activated phenotype (CAF).

CAF promotes malignant growth, angiogenesis, invasion and metastasis. The role of CAFS and their potential as cancer therapeutic targets has been studied in xenograft models, and evidence from translational studies has revealed the prognostic significance of CAF in various cancer types.

In the context of tumor growth, CAFs are activated and highly integrated, acidic and abundantly secreted in, for example, type I and IV collagen, extra domain A-fibronectin, heparin sulfate proteoglucan, cysteine. It secretes proteins tenascin-C, connective tissue growth factor, MMPs, and plasminogen activator. In addition to secreting growth factors and cytokines that influence cell motility, CAFs are important sources for proteases that degrade the ECM, such as MMPs, which play a variety of important roles in tumorigenesis. Through ECM degradation, MMPs can promote tumor growth, invasion, angiogenesis, inflammatory cell recruitment, and metastasis in a substrate-dependent manner. Moreover, many pro-inflammatory cytokines appear to be activated by MMPs.

After injection of B16M melanoma cells in mice, the formation of liver metastases was due to the early activation of stellate cells (fibroblast-like) in the liver, as these appeared to be important for creating the metastatic niche and promoting angiogenesis. related to transformation. MMPs have also been associated with tumor angiogenesis in various in vivo models. CAF promoted otherwise non-invasive cancer cell invasion when co-injected into mice. Moreover, xenografts containing CAFs apparently grow faster than standard fibroblast-injected xenografts.

Upon recruitment and accumulation of CAFs in the tumor stroma, these cells actively communicate with cancer, epithelial, endothelial, pericyte, and inflammatory cells by secreting various growth factors, cytokines, and chemokines. CAFs provide potent tumorigenic molecules such as TGF-β and hepatocyte growth factor (HGF).

TGF-β is a pleiotropic growth factor expressed by both cancer and stromal cells. TGF-β is a tumorigenic suppressor gene in normal and precancerous cells, but as cancer cells progress, the anti-proliferative effects are lost and TGF-β is replaced by invasive cancer cells. Promotes tumorigenesis by inducible phenotypic differentiation. TGF-β also guides cancer progression by evading immune surveillance, and increased expression of TGF-β is strongly associated with the accumulation of fibrotic adherent tissue and cancer progression. Recently, small-molecule inhibitors of the type I receptor for TGF-β were reported to inhibit the production of connective tissue growth factor by hepatocellular carcinoma (HCC) cells, resulting in a reduction of HCC stromal components. rice field. Inhibition of TGF-β receptors stopped the cross-talk between HCC and CAF, resulting in avoidance of tumor growth, invasion and metastasis. HGF belongs to the plasminogen family and is restricted to the ECM in the precursor form. It binds to the high affinity receptor c-met and overexpression or constant oncogenic c-Met signaling leads to proliferation, invasion and metastasis.

PDGF is a regulator of fibroblasts and pericytes and plays an important role in tumor progression. It is chemotactic and a growth factor for mesenchyme and endothelial cells. It has a limited autocrine role in tumor cell replication, but is a potential player in the paracrine manner and development of the tumor stroma. It induces proliferation of activated fibroblasts and possibly indirectly recruits CAFs by stimulating TGF-β release from macrophages.

A tumor cannot progress without parallel expansion of the tumor stroma. Although we still do not grasp the precise mechanisms regulating fibroblast activation and their accumulation in cancer, the available evidence suggests that the tumor stroma or CAFs may be candidate targets for cancer therapy. Point out.

CAFs and MMPs represent potential new targets for integrative therapy and are thought to be two key regulators of tumors of epithelial origin, affecting both transformed and non-deformed components of the tumor environment. was taken. As previously stated, experience with MMP inhibitors has been unsuccessful so far. Evidence that CAFs differ epigenetically, perhaps genetically, from canonical fibroblasts is beginning to define these cells as potential targets for anticancer therapy. FAP, expressed in more than 90% of epithelial carcinomas, has emerged early as a promising candidate for targeting CAFs, and the potential therapeutic effects of its inhibition have recently been investigated. In preclinical studies, withdrawal of FAP reduces tumor growth and significantly enhances tumor tissue uptake of anticancer agents. In a phase 1 trial in which patients with FAP-positive advanced carcinomas (colorectal cancer and NSCLC) were treated with FAP antibodies, the antibodies bound clearly to the primary sites, but no objective responses were observed. I didn't.

Consistent and repeated findings of cancer cells that readily undergo invasion and metastasis in response to TGF-β pointed to the need for new anticancer agents that target the oncogenic activity of TGF-β. . A number of anti-TGF-β antibodies and TGF-β-receptor I kinases have been tested preclinically over the past decade. Due to lack of success, targeting of the TGF-β signaling system remains elusive. Both protumoral and anti-tumor effects are conferred on TGF-β, and the multifunctional nature of TGF-β apparently effectively targets its ligands, receptors, or downstream effectors. Note that it represents the greatest barrier for

<Pulmonary hypertension>
Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by a marked and sustained elevation of pulmonary arterial pressure. The disease results in right ventricular failure and death. Current therapeutic methods for the treatment of chronic pulmonary hypertension primarily provide symptomatic relief as well as some improvement in prognosis. Although all treatments have been proposed, no evidence is found to substantiate a direct antiproliferative effect for most methods. In addition, the use of most currently applied drugs is hampered either by unwanted side effects or inconvenient routes of administration. Pathological changes in hypertensive pulmonary arteries include endothelial damage, proliferation, and hypercontraction of vascular smooth muscle cells (SMC).

The World Health Organization has divided pulmonary hypertension (PH) into five groups. These groups are organized on the basis of disease etiology and treatment options. In all groups, the mean pulmonary artery pressure is greater than or equal to 25 mmHg. A normal pulmonary artery pressure is 8-20 mmHg at rest. (Note that Group 1 is called Pulmonary Arterial Hypertension (PAH) and Groups 2-5 are called Pulmonary Hypertension. However, all groups are collectively called Pulmonary Hypertension.) Group 1 Pulmonary Arterial Hypertension PAH with no known cause; inherited PAH; PAH caused by drugs or toxins, such as over-the-counter drugs and certain diet pills; connective tissue disease, HIV infection, liver disease, congenital heart disease, etc. including PAH caused by diseases of These are heart diseases present at birth, sickle cell disease, schistosomiasis. This is an infection caused by parasites. Schistosomiasis is one of the most common causes of PAH in much of the world; and PAH caused by diseases that affect the veins and microvasculature of the lungs. Group 2 pulmonary hypertension includes PH with left heart disease. Diseases affecting the left side of the heart, such as mitral valve disease or long-term high blood pressure, can cause left heart disease and PH. Left heart disease is probably the most common cause of PH. Group 3 pulmonary hypertension includes PH associated with pulmonary diseases such as COPD (chronic obstructive pulmonary disease) and interstitial lung disease. Interstitial lung disease causes scarring of lung tissue. Group 3 also includes PH associated with sleep-related breathing disorders such as sleep apnea. Group 4 pulmonary hypertension includes PH caused by blood clots or blood clotting disorders in the lungs. Group 5 pulmonary hypertension includes PH caused by a variety of other diseases or conditions. Examples include: hematological diseases such as polycythemia vera and essential thrombocythemia, systemic diseases such as sarcoidosis and vasculitis. Systemic diseases involve many of the body's organs and metabolic disorders such as thyroid disease and glycogen storage disease. (In glycogen storage diseases, the body's cells do not properly use the form of glucose.) And other diseases such as tumors that affect the pulmonary arteries and kidney disease.

Various growth factors have been implicated in abnormal proliferation and migration of SMCs, including PDGF, basic FGF (bFGF), and EGF. In vitro studies have established that PDGF acts as a potent mitogen and chemoattractant for SMC. Active PDGF is composed of polypeptides (A and B chains) that form homodimers or heterodimers and stimulate α and β cell surface receptors. Recently, two additional PDGF genes have been identified, encoding PDGF-C and PDGF-D polypeptides. The PDGF receptor (PDGFR) belongs to the family of transmembrane receptor tyrosine kinases (RTKs), speculated to be held together by bivalent PDGF ligands. This complex of dimeric receptor and PDGF results in RTK autophosphorylation and increased kinase activity.

Both receptors activate major signaling transduction pathways, including RAS/MAPK, PI3K, and phospholipase Cγ. Recently, upregulation of both PDGFRα and PDGFRβ was shown in sheep with chronic intrauterine pulmonary hypertension. However, pulmonary PDGF-A or PDGF-B mRNA did not differ between pulmonary hypertensive and control animals. PDGF-A chain expression was markedly elevated in lung biopsies from patients with severe pulmonary arterial hypertension (PAH).

PDGF-A and PDGF-B mRNA synthesis and basal levels of PDGF-A and PDGF-B mRNA and PDGF isoforms are elevated in bleomycin-treated lungs. We observed that pirfenidone abrogates PDGF-A and PDGF-B levels, presumably through post-transcriptional or translational mechanisms resulting in reduced PDGF-A and PDGFB proteins. Furthermore, we observed that pirfenidone reduced bleomycin-induced pulmonary fibrosis by down-regulating the protein expression of PDGF-B as well as PDGF-A.

Since altered PDGF signaling plays an important role during PAH, pirfenidone or pyridone analogues also have positive effects on hemodynamics and pulmonary vascular remodeling in PAH, and in the treatment of this disease. serves as an anti-remodeling treatment for

The present invention, in some embodiments as disclosed herein, provides rapid and sustained availability of therapeutically useful pirfenidone or pyridone analog levels to one or more desired tissues. Compositions and methods for compound formulation of pirfenidone and pyridone analogs are provided that provide unprecedented advantages with respect to localized delivery of pirfenidone or pyridone analogs in an enabling manner.

In certain preferred embodiments, and as described in more detail below, pirfenidone or pyridone analog compound formulations are administered to airway tissues in a mammalian subject, e.g. It is delivered to the airways and/or to the pulmonary beds (eg alveolar-capillary beds). According to certain particularly preferred embodiments, delivery to these regions of the lung may be achieved by inhalation therapy of pirfenidone or pyridone analog compound formulations as described herein.

Although these and related embodiments beneficially provide therapeutic and/or prophylactic benefit by making a therapeutically effective pirfenidone or pyridone analog available to desired tissues shortly after administration, The same dosing event also provides a surprisingly sustained period of time during which locally delivered pirfenidone or pyridone analogs are available for extended therapeutic effect.

The compositions and methods disclosed herein provide such rapid and sustained local delivery of pirfenidone or pyridone analog compounds to a wide variety of tissues. pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, cardiac fibrosis, transplantation (e.g., lung, liver, kidney, heart, etc.), vascular grafts, and/or multiple sclerosis, etc. Embodiments are contemplated for the treatment of a number of clinically significant diseases, including other diseases, for which rapid and sustained bioavailable treatment with pirfenidone or pyridone analogs is indicated. obtain.

Thus, various embodiments use aerosol administration and via delivery of high concentrations (or dry formulations) (direct exposure of sustained-release active drug to affected tissue) to humans and/or or compositions and methods for optimal prophylactic and therapeutic activity in the prevention and treatment of pulmonary fibrosis in veterinary subjects. In particular, in certain preferred embodiments, concentrated doses of pirfenidone or pyridone analogs are delivered.

Without being bound by theory, according to certain of these and related embodiments as described in more detail herein, the pirfenidone or pyridone analog is directed to the site of desired effect. Provided in formulations having components selected to deliver effective doses of pirfenidone or pyridone analogs following aerosol administration of liquid, dry powder, or metered dose formulations that provide rapid and sustained topical delivery. .

According to certain related embodiments, by controlling the total amount of dissolved solutes in a pirfenidone or pyridone analogue compound formulation, by non-limiting theory, a nebulized liquid formed from an aqueous solution of such formulation The result is an aqueous pirfenidone or pyridone analog compound formulation with therapeutically beneficial properties, including particulate properties. Further, as disclosed herein, within the parameters provided herein for pirfenidone or pyridone analog compound concentration, pH, and total solute concentration, the upper portion of the total solute concentration range ( It has been discovered that the tolerance of formulations at or near the upper portion can be increased by the inclusion of flavoring agents as provided herein.

It was unexpectedly observed that exposure of inhaled pirfenidone to the lung surface resulted in depletion of lung surface cations and increased propensity for acute toxicity. The apparent mechanism for this deficiency is the ability of pirfenidone to chelate ions such as iron(III) at a rate of 3 pirfenidone molecules per iron(III) ion. Chelation of iron (III) occurs at half the strength of EDTA chelation. One way to prevent ion depletion of the lung surface is to formulate pirfenidone with multivalent ions. By way of non-limiting example, such polyvalent cations may include iron(II), iron(III), calcium, magnesium, and the like. By way of non-limiting example, formulations of pirfenidone were found to chelate magnesium in a ratio of two pirfenidone molecules to one magnesium ion. Thus, formulations between about 2 to 10 pirfenidone molecules with one magnesium molecule result in the chelation capacity of pirfenidone being filled or saturated, reducing pirfenidone's ability to deplete lung surface cations. Combining this solution with the need to control the osmotic pressure and osmotic ionic content of the formulation, salt forms of polyvalent ions can also be beneficial. By way of non-limiting example, the use of magnesium chloride to formulate pirfenidone reduces pirfenidone's ability to deplete essential lung surface cations, contributes to regulation of the osmotic pressure of the formulation, and reduces chloride penetration into the formulation. play a role in providing sexual ions. In certain such embodiments, pirfenidone or pyridone analog compound formulations, including, for example, pirfenidone or pyridone analog alone or those formulated with excipients, are aerosolized into the nasal or pulmonary compartment. and dissolved in a simple aqueous solution that can be injected or inhaled. Such formulations may include polyvalent cations and/or at concentrations of at least 34 mcg/mL to about 463 mg/mL and at least 100 mOsmol/kg to about 6000 mOsmol/kg, or 300 to about 5000 mOsmol/kg. can be buffered to a pH of from about 4.0 to about 11.0, more preferably from a pH of about 4.0 to a pH of about 8.0, with a total osmotic pressure of about 4.0 to about 11.0. Such simple aqueous formulations may further comprise a flavoring agent, thereby rendering them acceptable for inhaled administration (i.e., overriding undesirable taste or irritant properties that would otherwise interfere with effective therapeutic administration). . Therefore, and as also described herein in more detail, specific treatments can be achieved by controlling formulation conditions with respect to pH, buffer type, concentration of pirfenidone or pyridone analogues, total osmolarity and potential taste-masking agents. The above and other advantages are provided.

In certain such embodiments, for example, at least 0.1 mg to about 100 mg of the pirfenidone or pyridone analog compound formulation can be dispersed and infused into the nasal or pulmonary compartments or inhaled. In particular, it includes pirfenidone or pyridone analogs either alone or formulated with excipients such as polyvalent cations that provide improved stability and/or dispersibility in dry powder formulations. Therefore, as also described in more detail herein, the stability of dispersion excipients, pirfenidone or pyridone analogues (by non-limiting examples, polymorphs, amorphous content ) and moisture), the amount of pirfenidone or pyridone analogues and the control of formulation conditions for potential flavoring agents provide certain therapeutic and other benefits.

In certain such embodiments, for example, at least 0.1 mg to about 100 mg of a pirfenidone or pyridone analog compound formulation can be aerosolized and infused into the nasal or pulmonary compartment, or inhaled. As such, pirfenidone or pyridone analogs have been included in pressurized metered dose inhaler configurations that provide improved stability and/or aerosol properties. Therefore, as also described in more detail herein, by controlling the propellant, the appropriate pressurized metered dose inhaler canister, the formulation conditions for the stability of the pirfenidone or pyridone analogs, specific therapeutic and other advantages are provided.

In certain preferred embodiments, pirfenidone or pyridone analog compound formulations or salts thereof can function as prodrugs, sustained release or active agents in the formulations and compositions disclosed herein and (including lung bed, nose and sinuses), and other parenteral topical compartments including but not limited to skin, rectum, vagina, urethra, bladder, eye, and ear. It can be delivered under conditions and for a sufficient time to effect the concentration. As disclosed herein, certain particularly preferred embodiments provide pulmonary delivery of a pirfenidone or pyridone analog compound to the pulmonary vasculature so that it can be reached via the circulatory system. The lower respiratory tract, in other words, the lungs, as may be effected by such "pulmonary delivery" that provides effective amounts of the pirfenidone or pyridone analog compounds to compartments and/or other tissues and organs. administration via oral and/or nasal inhalation of pirfenidone or pyridone analogue compounds to the compartments of the respiratory tract (eg, respiratory bronchus, alveolar ducts, and/or alveoli).

Certain embodiments disclosed herein are important prophylactically or therapeutically because different formulations are known to have varying efficacies depending on dosage, form, concentration and delivery characteristics. Specific formulation and delivery parameters are provided that produce inflammatory, anti-fibrotic, anti-demyelinating and/or tissue remodeling results. Accordingly, these and related embodiments preferably include pirfenidone or pyridone analog compounds, such as pirfenidone or pyridone analogs alone or salts thereof. However, as indicated above, the present invention is not intended to be so limited and may relate to pirfenidone or salts thereof according to particularly preferred embodiments. Other contemplated embodiments may relate to another pyridone analog compound, such as the pyridone analog compounds disclosed herein.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is used in a desired manner, e.g., to prevent, manage, or treat patients with pulmonary fibrosis. mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols to provide effective concentrations or amounts to provide anti-inflammatory, anti-fibrosis or tissue remodeling benefits of is formulated to allow administration of

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, embodiments disclosed herein are useful for, by non-limiting examples, infection, radiotherapy, chemotherapy, environmental Protection against and treatment of pulmonary fibrosis associated with inhalation of pollutants (e.g. dust, vapors, fumes, and inorganic and organic fibers), hypersensitivity, silicosis, fibrosis, genetic factors and transplant rejection Specific formulations and delivery parameters are provided that result in

These and related applications are also contemplated for use in diseased lungs, sinuses, nasal cavities, heart, kidneys, liver, nervous system and related blood vessels. The pirfenidone or pyridone analog compound formulations and methods described herein can be used with commercially available inhalation devices or other devices for aerosol therapeutic agent administration.

By way of non-limiting example, in preferred embodiments, pyridone analog compounds (e.g., pirfenidone) as provided herein are used to prevent, manage, e.g., cardiac fibrosis in human and/or veterinary subjects. or mists, gas-liquid suspensions or nebulized liquids, dry powders to provide effective concentrations or amounts to provide the desired anti-inflammatory, anti-fibrotic or tissue remodeling benefits for treatment. and/or formulated to allow administration of a metered dose aerosol. Such embodiments are directed to pirfenidone or pyridone analog compounds to the pulmonary vasculature immediately upstream of the left atrium, and thus to the coronary arterial system with intravaginal atrial and ventricular exposure. Provides direct and high concentration delivery.

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, the embodiments disclosed herein are suitable for, by non-limiting examples, infection, surgery, radiation therapy, chemical therapy. Specific formulations and delivery parameters are provided that provide protection against and treatment for cardiac fibrosis associated with therapy and transplant rejection.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is administered to a desired anti-inflammatory agent, e.g., to prevent, manage, or treat renal fibrosis. Administration of mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols to provide effective concentrations or amounts to provide inflammatory, anti-fibrosis or tissue remodeling benefits. is formulated to allow Such embodiments are directed to pirfenidone or pyridone analog compounds directly into the pulmonary vasculature just upstream of the left atrium, left ventical, and thus into the renal vasculature. Provides high concentration delivery.

Since different formulations are known to vary in effectiveness depending on dosage, form, concentration and delivery characteristics, embodiments disclosed herein are useful for, by non-limiting examples, infections, ureteral stones, malignant hypertension. It provides specific formulations and delivery parameters that provide protection against and treatment for renal fibrosis associated with , radiation therapy, diabetes, heavy metal exposure, chemotherapy and transplant rejection.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is used in a desired manner, e.g., to prevent, manage, or treat cardiac or renal toxicity. to enable administration of mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols to provide effective concentrations or amounts that provide the anti-inflammatory benefits of formulated. Such embodiments provide direct and high concentrations of pirfenidone or pyridone analog compounds to the left atrium, pulmonary vasculature immediately upstream of the left ventricle, and thus to the heart and renal vasculature. provide delivery of

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, the embodiments disclosed herein are, by way of non-limiting example, associated with chemotherapy, cardiac or renal Specific formulations and delivery parameters are provided that provide protection against and treatment for the toxicity of

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is administered to a desired anti-inflammatory agent, e.g., to prevent, manage, or treat liver fibrosis. Administration of mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols to provide effective concentrations or amounts to provide inflammatory, anti-fibrosis or tissue remodeling benefits. is formulated to allow Such embodiments provide direct and high-concentration delivery of pirfenidone or pyridone analog compounds to the left atrium, pulmonary vasculature immediately upstream of the left ventricle, and thus to the liver vasculature. I will provide a.

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, embodiments disclosed herein are, by non-limiting examples, liver infections, hepatitis, alcohol overdose, Specific formulations and delivery parameters are provided that provide protection against and treatment for liver fibrosis associated with autoimmune diseases, radiotherapy, chemotherapy and transplant rejection.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is used to treat, e.g., multiple sclerosis, as desired. Nasal injection or inhalation of mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered doses to provide effective concentrations or amounts to provide anti-inflammatory and/or anti-demyelinating benefits. It is formulated to allow administration of an aerosol, either as an oral or orally inhaled aerosol. When via oral inhalation, such embodiments provide direct and high doses of pirfenidone or pyridone analogue compounds to the left atrium, pulmonary vasculature immediately upstream of the left ventricle, and thus to the central nervous system. Provides concentration delivery. When by nasal injection or nasal inhalation, such embodiments provide direct and high-concentration delivery of pirfenidone or pyridone analog compounds to the nasal and sinus vasculature immediately upstream of the central nervous system. offer.

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, the embodiments disclosed herein provide protection against and treatment for multiple sclerosis. provides formulation and delivery parameters for

By way of non-limiting example, in preferred embodiments, pyridone analog compounds (e.g., pirfenidone) as provided herein are used to treat chronic obstructive pulmonary disease (COPD), including, for example, emphysema and chronic bronchitis. mists, gas-liquids to provide effective concentrations or amounts to provide desired anti-inflammatory, anti-fibrotic or tissue remodeling benefits for preventing, managing or treating patients with diseases associated with It is formulated to allow administration as a suspension or nebulized liquid, dry powder and/or metered dose aerosol.

Since different formulations are known to vary in efficacy depending on dosage, shape, concentration and delivery characteristics, embodiments disclosed herein are, by way of non-limiting example, pipe, cigar and tobacco smoke, Specific formulations and delivery parameters are provided that provide protection against and treatment for COPD associated with exposure to secondhand smoke, air pollution, and chemical fumes or dust, and/or alpha-1 antitrypsin deficiency.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is administered to a desired patient, e.g., to prevent, manage, or treat a patient with asthma. Formulated to allow administration of mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols to provide effective concentrations or amounts that provide anti-inflammatory benefits. be done.

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, embodiments disclosed herein are, by non-limiting examples, motility, genetics, aeroallergens, Specific formulations and delivery parameters are provided that provide protection against and treatment for inhaled irritants such as pipe, cigar and tobacco smoke, and asthma associated with childhood respiratory infections.

By way of non-limiting example, in a preferred embodiment, pyridone analog compounds (e.g., pirfenidone) as provided herein are used for the prevention, management, or treatment of patients with cystic fibrosis, e.g. , mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose inhalers to provide effective concentrations or amounts to provide the desired anti-inflammatory, anti-fibrotic or tissue remodeling benefits. It is formulated to allow administration as an aerosol. Such embodiments may include co-formulation or co-administration of the pyridone analog compound with antibiotics, steroids, hyperosmotic solutions, DNAse or other mucus thinning agents, or other agents.

Since different formulations are known to vary in efficacy depending on dosage, form, concentration and delivery characteristics, the embodiments disclosed herein provide protection against and treatment for cystic fibrosis, provides formulation and delivery parameters for

For the applications described herein, the nebulized liquid, dry powder or metered aerosol pirfenidone or pyridone analog compound (or salt thereof) can be co-administered or can be administered sequentially. or antimicrobials (e.g. other aminoglycosides such as tobramycin and/or amikacin, aztreonam and/or other beta or mono-bactam, ciprofloxacin, levofloxacin and/or others, fluoroquinolones, azithromycin and/or or other macrolides or ketolides, tetracyclines and/or other tetracyclines, quinupristin and/or other streptogramins, linezolid and/or other oxazolidinones, vancomycin and/or other glycopeptides, and chloramphenicol and/or or other fenicol, and colistin and/or other polymyxins), bronchodilators (e.g. beta-2 agonists and muscarinic antagonists), corticosteroids (e.g. salmeterol, fluticasone and budesonide), glucocorticoids (e.g. prednisone), cromolyn, nedocromil, leukotriene modifiers (e.g. montelukast, zafirlukast and zileuton) hyperosmotic solutions, DNAse or other mucus thinning agents, interferon gamma, cyclophosphamide, colchicine, N-acetylcysteine, azathioprine, bromhexine , endothelin receptor antagonists (e.g. bosentan and ambrisentan), PDE5 inhibitors (e.g. sildenafil, vardenafil and tadalafil), PDE4 inhibitors (e.g. roflumilast, cilomilast, oglemilast, tetomilast and SB256066), prostanoids (e.g. epopulos) tenol, iloprost and treprostinin), nitric oxide or nitric oxide donating compounds, IL-13 blockers, IL-10 blockers, CTGF-specific antibodies, CCN2 inhibitors, angiotensin converting enzyme inhibitors, angiotensin receptors Antagonists, PDGF inhibitors, PPAR antagonists, imatinib, CCL2 specific antibodies, CXCR2 antagonists, triple growth factor kinase inhibitors, anticoagulants, TNF blockers, tetracyclines or tetracycline derivatives, 5-lipoxygenase inhibitors, pituitary hormones inhibitors, TGF-β-neutralizing antibodies, copper chelators, angiotensin II receptor antagonists, chemokine inhibitors, NF-kappaB inhibitors, NF-kappaB antisense oligonucleotides, IKK-1 and 2 inhibitors (e.g. imidazoquinoxalines or derivatives, and quinazolines or derivatives), JNK2 and/or p38 MAPK inhibitors (e.g. pyridylimidazolbutyn-I-ol, SB856553, SB681323, diaryl ureas or derivatives, and indole-5- carboxamides), PI3K inhibitors, LTB4 inhibitors, antioxidants (e.g. Mn-Pentaazatetracyclohexacosatriene, M40419, N-Acetyl-L-cysteine, Mucomist, Fluimucil, Nacysterin, Erdostein), Ebeselen, thioredoxin, glutathione peroxidase memetrix, curcumin C3 complex, resveratrol and analogues, tempol, catalytic antioxidants, and OxSODrol), TNF scavengers (e.g. infliximab, ethercept, adalimimab, PEG-sTNFR1, afelimomab, and antisense TNF-alpha oligonucleotides), interferon beta-1a (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), natalizumab (Tysabri), methotrexate, azathioprine (Imuran), Fixed combinations with intravenous immunoglobulin (IVIg), cyclophosphamide (Cytoxan), lioresal (Baclofen), tizanidine (Zanaflex), benzodiazepines, cholinergic agents, antidepressants and amantadine may be prepared.

"Cocktail therapy" or "cocktail therapy" in fibrotic diseases, more specifically idiopathic pulmonary fibrosis and other pulmonary fibrotic diseases, has been shown to be a promising approach to treat cancer and pulmonary arterial hypertension. Drugs targeting cancer, fibrotic or inflammatory diseases may be co-administered, sequentially administered, or co-formulated (drugs as combination therapy to treat the same Methods of administering pirfenidone or pyridone analogs as required by the prescribing physician to be obtained in some sequence of are described. By way of non-limiting example, analogs of pirfenidone or pyridone include monoclonal GS-6624 (formerly known as AB0024), analogs, or connective tissue regeneration to reduce inflammation, tumor stroma, and/or fibrosis. Administered in a fixed combination, co-administered, sequentially administered, or co-formulated with another antibody that targets a synthesis-associated LOXL2 protein. By way of another non-limiting example, analogs of pirfenidone or pyridone include IW001 (Type V collagen), analogs, or others targeting immune tolerogenicity to reduce inflammation, tumor stroma, and/or fibrosis. of collagen in a fixed combination, co-administered, sequentially administered, or co-formulated. By way of another non-limiting example, analogs of pirfenidone or pyridone include PRM-151 (recombinant Pentraxin-2), analogs, or control of the injury response to reduce inflammation, tumor stroma, and/or fibrosis. It is administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other targeted molecules. By way of another non-limiting example, a pirfenidone or pyridone analog is administered in fixed combination with CC-930 (a Jun kinase inhibitor), an analog, or other Jun kinase inhibitor to reduce the inflammatory response. , co-administered, administered sequentially, or formulated at the same time. By way of another non-limiting example, analogs of pirfenidone or pyridone are imatinib (aka Gleeve or Glivec (tyrosine kinase inhibitors)), analogs, or lung fibroblast-myofibroblast transformation and proliferation, as well as PDFG and administered in fixed combination, co-administered, or sequentially with other tyrosine inhibitors to inhibit extracellular matrix production and tumor stroma formation/maintenance by inhibiting transforming growth factor (TGF) administered at the same time or formulated at the same time. By way of another non-limiting example, analogs of pirfenidone or pyridone include STX-100 (monoclonal antibody targeting integrin alpha-vbeta-6), analogs, or Integrin alpha-vbeta-6 or other antibodies that target other integrins are administered in a fixed combination, co-administered, sequentially administered, or co-formulated. By way of another non-limiting example, analogs of pirfenidone or pyridone include QAX576 (a monoclonal antibody that targets interleukin 13 [IL-13]), analogs, or IL-12 to reduce tumor stroma and/or inflammation. Administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies targeting 13. By way of another non-limiting example, analogs of pirfenidone or pyridone include FG-3019 (a monoclonal antibody targeting connective tissue growth factor [CTGF]), analogs, or It is administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies that target CTGF. By way of another non-limiting example, analogs of pirfenidone or pyridone are CNTO-888 (monoclonal antibody targeting chemokine [CC motif] ligand 2 [CCL2]), analogs, or tumor stroma and/or fibrosis. Administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies that target CCL2 for reduction. By way of another non-limiting example, pirfenidone or a pyridone analog administered in fixed combination with Esbriet, Pirespa or Pirfenex (trade names for pirfenidone), or analogs targeting inflammation, tumor stroma, and/or fibrosis administered simultaneously, administered sequentially, or formulated at the same time. By way of another non-limiting example, a pirfenidone or pyridone analog is BIBF-1120 (Vargatef; triplex targeting vascular endothelial growth factor [VEGF], platelet-derived growth factor [PDGF] and fibroblast growth factor [FGF]). (also known as kinase inhibitors of ), analogs or other triple kinase inhibitors to reduce fibrosis, tumor stroma, and/or inflammation, administered in fixed combination or co-administered , administered sequentially, or formulated simultaneously.

Oral and parenteral administration (by non-limiting examples, intravenous and subcutaneous) of other compounds, molecules, and antibodies that target the reduction of inflammation, tumor stroma, and/or fibrosis upon administration of pirfenidone The pathways are often associated with adverse reactions such as, by way of non-limiting example, gastrointestinal side effects, hepatic, renal, cutaneous, cardiovascular or other toxicities. As described herein for analogs of pirfenidone or pyridone, the benefits of direct oral or intranasal inhalation to the lungs or tissues immediately downstream of the nasal and/or pulmonary compartments may also be useful for these compounds. Become. Thus, by way of non-limiting example, monoclonal GS-6624 (formerly known as AB0024), analogs, or LOXL2 associated with connective tissue biosynthesis to reduce inflammation, tumor stroma, and/or fibrosis Other antibodies that target proteins can be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, PRM-151 (recombinant Pentraxin-2), analogs, or other molecules that target regulation of the injury response to reduce inflammation, tumor stroma, and/or fibrosis are , orally or by intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, CC-930 (a Jun kinase inhibitor), analogs, or other Jun kinase inhibitors for reducing tumor stroma and/or inflammatory response may be administered immediately downstream of the nasal or pulmonary compartment. It may be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues. By other non-limiting examples, imatinib (aka Gleeve or Glivec (tyrosine kinase inhibitor)), analogs, or lung fibroblast-myofibroblast transformation and proliferation, as well as PDFG and transforming growth factor (TGF) Other tyrosine inhibitors for inhibiting extracellular matrix production and tumor stroma formation/maintenance by inhibiting the oral or nasal cavity for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment It can be administered by inhalation within the body. By another non-limiting example, STX-100 (monoclonal antibody targeting integrin alpha-vbeta-6), analogs, or integrin alpha-vbeta-6 to reduce tumor stroma and/or fibrosis Or other antibodies that target other integrins may be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, QAX576 (a monoclonal antibody that targets interleukin 13 [IL-13]), analogs, or other antibodies that target IL-13 to reduce tumor stroma and/or inflammation. Antibodies may be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, FG-3019 (a monoclonal antibody that targets connective tissue growth factor [CTGF]), analogs, or other antibodies that target CTGF to reduce fibrosis may be administered in the nasal or lung It may be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the compartment of the lung. By way of another non-limiting example, CNTO-888 (a monoclonal antibody targeting the chemokine [CC motif] ligand 2 [CCL2]), analogs, or CCL2 to reduce tumor stroma and/or fibrosis. Other targeted antibodies may be administered by oral or intranasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, BIBF-1120 (Vargatef; also known as a triple kinase inhibitor that targets vascular endothelial growth factor [VEGF], platelet-derived growth factor [PDGF] and fibroblast growth factor [FGF]). ), analogs, or other triple kinase inhibitors to reduce tumor stroma and/or inflammation and/or fibrosis may be delivered directly to the lung or tissue immediately downstream of the nasal or pulmonary compartment. may be administered by oral or intranasal inhalation for

In fibrosis-associated pulmonary hypertension, more specifically type 3 pulmonary hypertension, "cocktail therapy" or "cocktail prophylaxis" has been shown to be a promising method for treating cancer and pulmonary arterial hypertension. In order to enable the "method", drugs targeting pulmonary hypertension, fibrosis, or inflammatory diseases (by the prescribing physician, drugs may be combined in some order as combination therapy to treat the same disease). Methods of administering pirfenidone or pyridone analogs, such as co-administration, sequential administration, or formulated simultaneously, as desired to obtain, are described. By way of non-limiting example, analogs of pirfenidone or pyridone include monoclonal GS-6624 (previously known as AB0024), analogs, or agents in connective tissue biogenesis to reduce inflammation, pulmonary hypertension, and/or fibrosis. It is administered in a fixed combination, co-administered, sequentially administered, or co-formulated with another antibody that targets a related LOXL2 protein. By way of another non-limiting example, analogs of pirfenidone or pyridone target IW001 (collagen V), analogs or immunogenic resistance to reduce inflammation, pulmonary hypertension, and/or fibrosis Administered fixedly, co-administered, sequentially, or co-formulated with another collagen. By way of another non-limiting example, analogs of pirfenidone or pyridone include PRM-151 (recombinant pentraxin-2), analogs, or modulation of the injury response to reduce inflammation, pulmonary hypertension, and/or fibrosis. It may be administered in a fixed combination, co-administered, sequentially administered, or co-formulated with another targeted molecule. By another non-limiting example, a pirfenidone or pyridone analog is administered in fixed combination with CC-930 (a Jun kinase inhibitor), an analog, or other Jun kinase inhibitor to reduce inflammatory responses. , co-administered, administered sequentially, or formulated at the same time. By way of another non-limiting example, analogues of pirfenidone or pyridone have been shown to reduce pulmonary fibroblast-myofibroblast transformation and proliferation as well as extracellular matrix production and pulmonary arterial hypertension through inhibition of PDFG and transforming growth factor (TGF). Imatinib (aka Gleeve or Glivec (tyrosine kinase inhibitors)), analogs, or other tyrosine inhibitors to also inhibit disease formation/maintenance, administered in fixed combination, co-administered, or sequentially administered at the same time or formulated at the same time. By way of another non-limiting example, analogs of pirfenidone or pyridone include STX-100 (monoclonal antibody targeting integrin alpha-vbeta-6), analogs, or , administered in fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies that target integrin alpha-vbeta-6. By way of another non-limiting example, analogs of pirfenidone or pyridone include QAX576 (a monoclonal antibody targeting interleukin-13 [IL-13]), analogs, or IL-1 to reduce pulmonary hypertension and/or inflammation. It is administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies targeting -13. By way of another non-limiting example, analogs of pirfenidone or pyridone include FG-3019 (a monoclonal antibody that targets connective tissue growth factor [CTGF]), analogs, or , administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies that target CTGF. By way of another non-limiting example, analogs of pirfenidone or pyridone are CNTO-888 (monoclonal antibody targeting chemokine [CC motif] ligand 2 [CCL2]), analogs, or pulmonary hypertension and/or fibrosis. Administered in a fixed combination, co-administered, sequentially administered, or co-formulated with other antibodies that target CCL2 for reduction. By way of another non-limiting example, pirfenidone or an analog of pyridone administered in fixed combination with Esbriet, Pirespa, or Pirfenex (trade name pirfenidone), or an analog targeting inflammation, pulmonary hypertension, and/or fibrosis administered simultaneously, administered sequentially, or formulated at the same time. By another non-limiting example, pirfenidone or pyridone analogs target BIBF-1120 (Vargatef; vascular endothelial growth factor [VEGF], platelet-derived growth factor [PDGF], and fibroblast growth factor [FGF] (also known as triple kinase inhibitors), analogs or other triple kinase inhibitors to reduce fibrosis, pulmonary hypertension, and/or inflammation, administered in fixed combination or co-administered administered simultaneously, administered sequentially, or formulated at the same time. By way of another non-limiting example, pirfenidone or pyridone analogs are combined with endothelin receptor antagonists (e.g., bosentan or ambrisentan) to treat pulmonary hypertension, tumor stroma, or fibrosis associated with cancer. administered in combination, co-administered, administered sequentially, or formulated at the same time. By way of another non-limiting example, pirfenidone or pyridone analogues are combined with PDE5 inhibitors (e.g., sildenafil, vardenafil, and tadalafil) to treat pulmonary hypertension, tumor stroma, or fibrosis associated with cancer. administered in combination, co-administered, administered sequentially, or formulated at the same time. By way of another non-limiting example, pirfenidone or pyridone analogs are used with prostinoids (e.g., epoprostenol, iloprost, and iloprost) to treat pulmonary hypertension, tumor stroma, or fibrosis associated with cancer. administered in a fixed combination, co-administered, sequentially or co-formulated with treprostinin. By way of another non-limiting example, pirfenidone or pyridone analogs are nitric oxide or nitric oxide donating compounds (e.g., nitrates, nitrites, nitrites, nitrites, nitrites) for treating pulmonary hypertension, tumor stroma, or fibrosis associated with cancer. nitrate, or inhaled nitrite) in a fixed combination, co-administered, sequentially, or co-formulated.

Oral and parenteral (including but not limited to intravenous and subcutaneous) administration of other compounds, molecules, and antibodies that target the reduction of inflammation, pulmonary hypertension, and/or fibrosis, similar to administration of pirfenidone. The route of administration of is frequently associated with adverse reactions such as, but not limited to, gastrointestinal side effects, hepatic, renal, dermal, cardiovascular, or other toxicities. The benefits of direct oral or nasal inhalation to the lungs or tissues immediately downstream of the nasal and/or pulmonary compartments, as described herein for analogs of pirfenidone or pyridone, also benefit these compounds. give. Thus, by way of non-limiting example, monoclonal GS-6624 (formerly known as AB0024), analogs, or LOXL2 protein associated with connective tissue biogenesis to reduce inflammation, pulmonary hypertension, and/or fibrosis Other antibodies targeting are administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal and/or pulmonary compartments. By way of another non-limiting example, PRM-151 (recombinant Pentraxin-2), analogs, or other molecules that target modulation of the injury response to reduce inflammation, pulmonary hypertension, and/or fibrosis are , by oral or nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, CC-930 (a Jun kinase inhibitor), analogs, or other Jun kinase inhibitors to reduce inflammatory responses may be administered directly to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. It may be administered orally or by nasal inhalation for delivery. By other non-limiting examples, imatinib (aka Gleeve or Glivec (tyrosine kinase inhibitor)), analogs, or lung fibroblast-myofibroblast transformation and proliferation, as well as PDFG and transforming growth factor (TGF) Other tyrosine inhibitors for inhibiting extracellular matrix production and pulmonary arterial hypertension by inhibiting , may be administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. . By another non-limiting example, STX-100 (a monoclonal antibody targeting integrin alpha-vbeta-6), analogs, or integrin alpha-vbeta- to reduce pulmonary hypertension and/or fibrosis. Other integrins that target 6 can be administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, QAX576 (a monoclonal antibody targeting interleukin 13 [IL-13]), an analog or others targeting IL-13 to reduce pulmonary hypertension and/or inflammation may be administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By way of another non-limiting example, FG-3019 (a monoclonal antibody targeting connective tissue growth factor [CTGF]), analogs or others targeting CTGF to reduce pulmonary hypertension and/or fibrosis may be administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By another non-limiting example, CNTO-888 (a monoclonal antibody targeting the chemokine [CC motif] ligand 2 [CCL2]), analogs, or CCL2 for reducing pulmonary arterial hypertension and/or fibrosis. Other targeted antibodies may be administered orally or by nasal inhalation for direct delivery to the lungs or tissues immediately downstream of the nasal or pulmonary compartment. By another non-limiting example, BIBF-1120 (Vargatef; also known as a triple kinase inhibitor that targets vascular endothelial growth factor [VEGF], platelet-derived growth factor [PDGF], and fibroblast growth factor [FGF]). ), analogs, or other triple kinase inhibitors for reducing pulmonary hypertension and/or fibrosis and/or inflammation, for delivery directly to the lung or tissue immediately downstream of the nasal or pulmonary compartment. Administration may be by oral or nasal inhalation. By way of another non-limiting example, endothelin receptor antagonists (eg, bosentan or ambrisentan) treat pulmonary hypertension associated with cancer, tumor stroma, or fibrosis. By way of another non-limiting example, PDE5 inhibitors (eg, sildenafil, vardenafil, and tadalafil) treat pulmonary hypertension associated with cancer, tumor stroma, or fibrosis. By way of another non-limiting example, prostanoids (eg, epoprostenol, iloprost, and treprostinil) treat pulmonary hypertension associated with cancer, tumor stroma, or fibrosis. By way of another non-limiting example, nitric oxide or nitric oxide contributing compounds (eg, nitrates, nitrites, or inhaled nitrites) treat pulmonary hypertension associated with cancer, tumor stroma, or fibrosis.

Targeting cancer to enable "cocktail therapy" or "cocktail prophylaxis" in cancer, more specifically lung cancer, has been shown to be a promising method for treating cancer and pulmonary arterial hypertension. (as required by the prescribing physician that the drugs are given in some order as combination therapy to treat the same disease), administered simultaneously, sequentially, or prescribed at the same time Methods of administering analogs of , pirfenidone or pyridone are described. Anti-cancer agents may include gefitinib (Iressa, also known as ZD1839). Gefitinib is a selective inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase domain. Target proteins (EGFR) are a family of receptors that includes Her1 (erb-B1), Her2 (erb-B2), and Her3 (erb-B3). EGFR is overexpressed in cells of certain types of human carcinomas, for example in lung and breast cancers. This leads to inappropriate activation of the anti-apoptotic Ras signaling cascade and ultimately to uncontrolled cell proliferation. Studies on gefitinib-sensitive non-small cell lung cancer have shown that mutations in the EGFR tyrosine kinase domain are responsible for activating anti-apoptotic pathways. These mutations tend to confer increased sensitivity to tyrosine kinase inhibitors such as gefitinib and erlotinib. Among the types of non-small cell lung cancer histology, adenocarcinoma is the type that harbors these mutations most frequently. These mutations are more commonly found in Asians, women, and nonsmokers (and tend to have adenocarcinoma more frequently). Gefitinib inhibits EGFR tyrosine kinase by binding to the adenosine triphosphate (ATP) binding site of the enzyme. Thus, the function of EGFR tyrosine kinase in activating the anti-apoptotic Ras signaling cascade is inhibited and malignant cells are inhibited. Although gefitinib has yet to prove effective in other cancers, it also has the potential to be used in the treatment of other cancers associated with EGFR overexpression. Because gefitinib is a selective chemotherapeutic agent, its tolerability profile is superior to previous cytotoxic agents. Adverse drug reactions (ADRs) are potentially fatally acceptable. Acne-like rashes are very commonly reported. Other common side effects include: diarrhea, nausea, vomiting, anorexia, stomatitis, dehydration, skin reactions, paronychia, subclinical elevation of liver enzymes, asthenia, conjunctivitis, blepharitis. Rare side effects include: interstitial lung disease, corneal erosions, abnormal eyelash and hair growth.

Another anticancer drug is erlotinib (also known as Tarceva). Erlotinib specifically targets the epidermal growth factor receptor (EGFR) tyrosine kinase, which is highly expressed and sometimes mutated in various forms of cancer. It binds in a reversible manner to the adenosine triphosphate (ATP) binding site of the receptor. For a signal to be transmitted, two EGFR molecules must come together to form a homodimer. They then use molecules of ATP that transphosphorylate each other on tyrosine residues, which generate phosphotyrosine residues to transduce signaling cascades to the nucleus or other cells. EGFR is recruited with phosphotyrosine-binding proteins to assemble protein complexes that activate the biochemical processes of EGFR. Inhibition of ATP does not allow the formation of phosphotyrosine residues in EGFR and initiates a signaling cascade. Erlotinib has shown survival benefit in the treatment of lung cancer. Erlotinib is approved for the treatment of locally advanced or metastatic non-small cell lung cancer that has failed at least one previous chemotherapy regimen. It is also approved in combination with gemcitabine for the treatment of locally advanced, unresectable, or metastatic pancreatic cancer. In lung cancer, erlotinib has been shown to be effective in patients with or without EGFR mutations, but appears to be more effective in the group of patients with EGFR mutations. The response rate among EGFR mutation-positive patients is approximately 60%. Non-smokers and ever-light smokers with adenocarcinomas or subtypes like BAC may have EGFR mutations, but mutations can occur in all types of patients. EGFR-positive patients are generally KRAS-negative. Erlotinib was recently shown to be a potent inhibitor of JAK2V617F activity. JAK2V617F is a mutant of the tyrosine kinase JAK2 and is found in most patients with polycythemia vera (PV) and in a substantial proportion of patients with idiopathic myelofibrosis or essential thrombocythemia. Studies suggest that erlotinib may be used to treat JAK2V617F-positive PV and other myeloproliferative disorders. A rash occurs in the majority of patients. It is similar to acne and primarily involves the face and neck. It is self-limiting and breaks down in the majority of cases even with continued use. Interestingly, several clinical studies have shown a correlation between the severity of skin reactions and increased survival, but this was not quantitatively assessed. Dermatoma may be a surrogate marker of clinical benefit. Other side effects include interstitial pneumonia characterized by diarrhea, loss of appetite, fatigue and, rarely, increased coughing and dyspnea. This is severe and must be considered in patients with severe respiratory deterioration. It has also been suggested that erlotinib can cause hearing loss. Rare side effects include severe gastrointestinal, skin, and eye problems. In addition, some people prescribed erlotinib have had severe or fatal gastrointestinal perforations; Some develop severe eye disease. Some of the cases, including those with eventual death, were indicative of Stevens-Johnson syndrome/toxic epidermal necrolysis. Erlotinib is metabolized primarily by the liver enzyme CYP3A4. Compounds that induce this enzyme (ie, stimulate its production), such as St. John's wort, can reduce erlotinib levels, while inhibitors can increase levels. Like other ATP-competitive small molecule tyrosine kinase inhibitors, such as imatinib in CML, patients develop resistance rapidly. For erlotinib, this typically occurs 8-12 months after initiation of treatment. More than 50% of the resistance is caused by mutations in the ATP-binding pocket of the EGFR kinase domain involving replacement of small polar threonine residues by large nonpolar methionine residues (T790M). Proponents of the 'gatekeeper' mutation hypothesis suggest that this mutation prevents binding of erlotinib through steric hindrance, but studies suggest that T790M reduces erlotinib's interfering effects of ATP-binding affinity. Suggest giving an increase. Approximately 20% of drug resistance is caused by amplification of the hepatocyte growth factor receptor driving ERBB3-dependent activation of PI3K. Other cases of resistance may involve multiple mutations, including recruitment of mutated IGF-1 receptors to homodimerize with EGFR and form heterodimers. This allows activation of downstream effectors of EGFR even in the presence of EGFR inhibitors. Several IGR-1R inhibitors are in various stages of development (based either around TKIs such as AG1024 or AG538, or pyrrolo[2,3-d]-pyrimidine derivatives such as NVP-AEW541). . The monoclonal antibody figitumumab, which targets IGF-1R, is currently undergoing clinical trials. Another cause of resistance may be inactivating mutations in the PTEN tumor suppressor that allow increased activation of Akt independent of stimulation by EGFR. Perhaps the most promising way to combat resistance is combination therapy. Initiating treatment with a number of different therapeutic agents with different modes of action appears to offer the best protection against the development of T790M and other resistance conferring mutations.

Another anti-cancer agent is Bortezomib (original codename PS-341; marketed as Velcade and Bortecad). Bortezomib is the first therapeutic proteasome inhibitor to be tested in humans. It is approved in the United States to treat recurrent multiple myeloma and mantle cell lymphoma. In multiple myeloma, complete clinical responses have been obtained in patients with otherwise resistant or rapidly progressing disease. Bortezomib was originally synthesized as MG-341. After expecting preclinical results, the drug (PS-341) was tested in a small phase I trial in patients with multiple myeloma cancer. Bortezomib (Velcade) is approved for use in multiple myeloma. Another commercially available bortezomib product—Bortenat—reportedly contains substantially more active entity than declared and potentially, even more, results in increased toxicity. In addition, Bortenat has several other chemical and formulation deviations from the documented ethical product Velcade with unclear clinical implications. The boron atom in bortezomib binds the catalytic site of the 26S proteasome with high affinity and specificity. In normal cells, the proteasome regulates protein expression and function by degrading ubiquitinated proteins and also cleans the cell of abnormal or misfolded proteins. Clinical and preclinical data support a role for myeloma cells in maintaining the immortal phenotype, and cell culture and xenograft data support a solid tumor cancer-like function. Although multiple mechanisms appear to be involved, proteasome inhibition may prevent the degradation of pro-apoptotic factors and allow activation of programmed cell death in tumor cells that depend on inhibition of pro-apoptotic pathways. Recently, it was found that bortezomib caused rapid and dramatic changes in the levels of proteasome-mediated intracellular peptides. Several intracellular peptides have been shown to be biologically active, so the effects of bortezomib on intracellular peptide levels may contribute to the drug's biological effects and/or side effects. Bortezomib is rapidly cleared after intravenous administration. Peak concentration is reached in about 30 minutes. Drug concentrations can no longer be measured after 1 hour. Pharmacodynamics are measured by measuring proteasome inhibition in peripheral blood mononuclear cells. The much greater sensitivity of myeloma and mantle cell lines to proteasome inhibition compared to standard peripheral blood mononuclear cells and most other cancer cell lines is poorly understood. Bortezomib is associated with peripheral neuropathy in 30% of patients; sometimes it can be painful. This may be worse than in patients with pre-existing neuropathies. In addition, myelosuppression leading to neutropenia and thrombocytopenia also occurs, which can be dose limiting. However, these side effects are usually mild for bone marrow transplantation and other treatment options for patients with advanced disease. Bortezomib is associated with a high rate of herpes zoster, but prophylactic acyclovir may reduce this risk. Gastrointestinal effects and asthenia are the most common adverse events. Established effects of bortezomib on days 1, 4, 8, and 11 of 21-day cycles for up to 8 cycles in heavily pretreated patients with relapsed/refractory multiple myeloma 1.3 mg/m2 (with or without dexamethasone), administered by an intravenous bolus of The demonstrated superiority of bortezomib is 1.3 mg/m2 over high-dose dexamethasone regimens (example median TTP 6.2 vs. 3.5 months and 1-year survival 80% vs. 66 %according to). Laboratory studies and clinical trials are investigating whether it may be possible to further increase the anticancer efficacy of bortezomib by combining it with new types of other pharmacological agents. For example, clinical trials have shown that the addition of thalidomide, lenalidomide, inhibitors of vascular endothelial growth factor (VEGF), or arsenic trioxide may be beneficial. In laboratory studies, it was found that bortezomib killed multiple myeloma cells more effectively when combined with, for example, histone deacetylase inhibitors, thapsigargin, or celecoxib. There is preclinical medical evidence that bortezomib is synergistic with Reolysin in pancreatic cancer. However, the therapeutic efficacy and safety of any of these later combinations have not yet been evaluated in cancer patients.

Another family of anti-cancer agents are the Janus kinase inhibitors. Also known as JAK inhibitors, they are a class of enzymes that function by inhibiting the activity of one or more of the Janus kinase family of enzymes (JAK1, JAK2, JAK3, TYK2), thereby interfering with the JAK-STAT signaling pathway. is a drug. These inhibitors have therapeutic uses in the treatment of cancer and inflammatory diseases. Cytokines play an important role in regulating cell proliferation and immune responses. Many cytokines function by binding to and activating type I and type II cytokine receptors. These receptors in turn depend on the Janus kinase (JAK) family of enzymes for signal transduction. Therefore, drugs that inhibit the activity of these Janus kinases block cytokine signaling pathways. More specifically, Janus kinase phosphorylates activated cytokine receptors. These phosphorylated receptors in turn recruit STAT transcription factors that regulate gene transcription. The first JAK inhibitor to reach clinical trials was tofacitinib. Tofacitinib is a specific inhibitor of JAK3 (IC50=2 nM), thereby blocking the activity of IL-2, IL-4, IL15 and IL-21. Th2 cell differentiation is therefore blocked and therefore tofacitinib is effective in treating allergic diseases. Tofacitinib also inhibits JAK1 (IC50=100 nM) and JAK2 (IC50=20 nM), which in turn blocks IFN-γ and IL-6 signaling and consequently Th1 cell differentiation, albeit to a lesser extent . Examples of JAK inhibitors include: ruxolitinib against JAK1/JAK2 for psoriasis, myelofibrosis, and rheumatoid arthritis; tofacitinib against JAK3 for psoriasis and rheumatoid arthritis (tasocitinib; CP-690550 ); Baricitinib (LY3009104, INCB28050) against JAK1/JAK2 for rheumatoid arthritis; CYT387 against JAK2 for myeloproliferative disorders; Lestaurtinib against JAK2 for acute myeloid leukemia (AML); and Pacritinib (SB1518) against JAK2 for advanced myelogenous malignancies, chronic idiopathic myelofibrosis (CIMF); and TG101348 against JAK2 for myelofibrosis.

Another family of anti-cancer agents are the ALK inhibitors. ALK inhibitors are potential anticancer agents that act against tumors due to mutations in anaplastic lymphoma kinase (ALK), such as the EML4-ALK transition. About 7% of non-small cell lung carcinomas (NSCLC) have an EML4-ALK rearrangement. Examples of ALK inhibitors include: crizotinib (trade name Xalkori) is approved for NSCLC; AP26113 is in preclinical stage; Developed by NPM-ALK is a different mutation/fusion of ALK that controls anaplastic large cell lymphoma (ALCL) and is the target of other ALK inhibitors. Crizotinib has the structure and function of an aminopyridine as a protein kinase inhibitor by competitive binding within the ATP binding pocket of target kinases. Approximately 4% of patients with non-small cell lung cancer have EML4 ("4-like echinoderm microtubule-attached It has a chromosomal rearrangement that creates a fusion gene between a protein (echinoderm microtubule-associated protein-like 4)”) and ALK (“Anaplastic Lymphoma Kinase”). Kinase activity of the fusion protein is inhibited by crizotinib. Patients with this gene fusion are typically younger, non-smokers who do not have mutations in the epidermal growth factor receptor gene (EGFR) or the K-Ras gene. The number of new cases of ALK-fused NSLC is approximately 9,000 per year in the United States and approximately 45,000 worldwide. ALK mutations appear to be important in controlling the malignant phenotype in about 15% of neuroblastoma cases, a rare form of peripheral nervous system cancer that occurs almost exclusively in very young children. Crizotinib inhibits the c-Met/hepatocyte growth factor receptor (HGFR) tyrosine kinase implicated in tumorigenesis of many other histologic forms of malignant neoplasm. Crizotinib is currently thought to exert its effects by modulating the proliferation, migration and invasion of malignant cells. Other studies suggest that crizotinib may also act through inhibition of angiogenesis in malignant tumors. Crizotinib shrank or stabilized tumors in 90% of the 82 patients carrying the ALK fusion gene. Tumors shrank by at least 30% in 57% of treated people. Most had adenocarcinoma and were never or ever smokers. They received an average of three other drug treatments before receiving crizotinib, and only 10% were expected to respond to standard therapy. They were given 250 mg of crizotinib twice daily for an intermediate duration of 6 months. Approximately 50% of these patients suffered at least one side effect such as nausea, vomiting, or diarrhea. Some responses to crizotinib lasted up to 15 months. A Phase 3 trial (PROFILE 1007) compares crizotinib to standard second-line chemotherapy (pemetrexed or taxotere) in the treatment of ALK-positive NSCLC. In addition, a Phase 2 trial (PROFILE 1005) studies patients meeting similar criteria who have received more than one line of prior chemotherapy. Crizotinib (Xalkori) is approved to treat certain late-stage (locally advanced or metastatic) non-small cell lung cancers that express an abnormal anaplastic lymphoma kinase (ALK) gene. Approval required testing of a companion molecule for the EML4-ALK fusion.

Another anti-cancer agent is crizotinib. Crizotinib is also being tested in clinical trials for advanced disseminated anaplastic large cell lymphoma and neuroblastoma.

Anti-cancer targets include Bcl-2 (B cell lymphoma 2). The BCL2 gene, encoded by the BCL2 gene, is a founding member of the Bcl-2 family of regulatory proteins that regulate cell death (apoptosis). The name Bcl-2 is derived from B-cell lymphoma 2, as it is the second member of a variety of proteins first described in chromosomal translocations involving chromosomes 14 and 18 in follicular lymphoma. Bcl-2 orthologs have been identified in many mammals for which complete genomic data are available. Two isoforms of Bcl-2, isoform 1, also known as 1G5M, and isoform 2, also known as 1G5O/1GJH, exhibit similar folds. However, the ability of these isoforms to bind BAD and BAK proteins, as well as the resulting structural topology and electrostatic potential of the binding cleft, suggest differences in anti-apoptotic activity for the two isoforms. do. Damage to the Bcl-2 gene has been identified as the cause of many cancers, including melanoma, breast, prostate, chronic lymphocytic leukemia, and lung cancer, as well as a possible cause of schizophrenia and autoimmune diseases was done. It is also responsible for resistance to cancer treatments. Cancer results from disturbances in the homeostatic balance between cell proliferation and cell death. Overexpression of anti-apoptotic genes and underexpression of pro-apoptotic genes can result in the lack of cell death that characterizes cancer. An example can be seen in lymphoma. Overexpression of the anti-apoptotic Bcl-2 protein in lymphocytes alone does not cause cancer. However, simultaneous overexpression of Bcl-2 and the proto-oncogene myc can lead to aggressive B-cell malignancies, including lymphomas. In follicular lymphoma, chromosomal translocations that place the bcl-2 gene next to the immunoglobulin heavy chain gene locus commonly occur between chromosomes 14 and 18 (t(14;18)). This fusion gene is deregulated, leading to excessively high levels of Bcl-2 transcription. This reduces the propensity of these cells to undergo apoptosis. Cell death also plays a very active role in regulating the immune system. If it is functional, it can cause immune non-response to self-antigens through both central and peripheral tolerance. In the case of defective apoptosis, it may contribute to aspects of autoimmune disease pathogenesis. An autoimmune disease, type 1 diabetes, can be caused by defective apoptosis leading to abnormal T-cell AICD and defective peripheral tolerance. Due to the fact that dendritic cells are the most important antigen-presenting cells of the immune system, their activity must be tightly regulated by such mechanisms as apoptosis. Researchers have found that mice containing dendritic cells that are Bim−/− and therefore unable to induce effective apoptosis get more autoimmune disease than those with standard dendritic cells. , found. Other studies have shown that dendritic cell lifespan can be partially controlled by an anti-apoptotic Bcl-2-dependent timer. Apoptosis plays a very important role in regulating various diseases with enormous social impact. Schizophrenia, for example, is a neurodegenerative disease that can result from an abnormal ratio of pro- and anti-apoptotic factors. There is some evidence that this defective apoptosis may result from abnormal expression of Bcl-2 and increased expression of caspase-3. Further studies of the family of Bcl-2 proteins will provide a more complete picture of how these proteins interact to promote and inhibit apoptosis. An understanding of the mechanisms involved can also help develop new therapies to treat cancer, autoimmune diseases, and neurological disorders. Bcl-2 inhibitors include: the antisense oligonucleotide drug Genasense (G3139), which targets Bcl-2. The antisense DNA or RNA strand is non-coding and complementary to the coding strand (which is the template for producing RNA or protein, respectively). Antisense drugs are short sequences of RNA that hybridize with mRNA, inactivating it and preventing proteins from forming. It was shown that proliferation of human lymphoma cells (with t(14;18) translocation) can be inhibited by antisense RNA targeted at the start codon region of Bcl-2 mRNA. In vitro studies have led to the identification of Genasense, which is complementary to the first six codons of Bcl-2 mRNA. Another BCL-2 inhibitor is ABT-73. ABT-73, also known as ABT-737, is a new inhibitor of Bcl-2, Bcl-xL, and Bcl-w. ABT-737 is a Bcl-2 and Bcl-2 related protein, such as Bcl-xL and Bcl-w, but not A1 and Mcl-1, that may prove beneficial in the treatment of lymphoma and other leukemias. is one of many so-called BH3 mimetic small molecule inhibitors (SMIs) that target Another inhibitor is ABT-199. ABT-199 is a so-called BH3 mimetic drug designed to block the function of Bcl-2 protein in patients with chronic lymphocytic leukemia. Another Bcl-2 inhibitor is Obatoclax (GX15-070) for small cell lung cancer. By inhibiting Bcl-2, Obatoclax induces cell death in cancer cells and prevents tumor growth.

Another family of anticancer agents is the PARP inhibitors. PARP inhibitors are a group of pharmacological inhibitors of the enzyme poly ADP ribose polymerase (PARP). They are developed for a number of indications; the most important being the treatment of cancer. Various forms of cancer depend on PARP more than normal cells, making PARP an attractive target for cancer therapy. In addition to their use in cancer therapy, PARP inhibitors are considered potential therapies for acute life-threatening diseases such as stroke and myocardial infarction, as well as long-term neurodegenerative diseases. DNA is damaged thousands of times during each cell cycle and the damage must be repaired. BRCA1, BRCA2, and PALB2 are proteins, or HRRs, pathways important for the repair of double-stranded DNA breaks by error-free homologous recombination recovery. When the gene for any protein is mutated, the changes can lead to errors in DNA repair that can ultimately lead to breast cancer. Once exposed to enough damage, the altered gene can cause cell death. PARP1 is an important protein for the repair of single-strand breaks (“nicks” in DNA). If such breaks remain unrepaired until the DNA is replicated (which must precede cell division), then the repair itself can cause double-strand breaks to form. Drugs that inhibit PARP1 cause multiple double-strand breaks to form in this manner, and in tumors with BRCA1, BRCA2, or PALB2 mutations, these double-strand breaks are not efficiently repaired and cell leading to the death of They repair DNA less frequently than cancer cells, and normal cells lacking any mutated BRCA1 or BRCA2 still have homologous repair actions that allow them to survive inhibition of PARP. . Although some cancer cells lacking the tumor suppressor PTEN may be sensitive to PARP inhibitors due to the downregulation of Rad51 (a critical homologous recombination component), other data suggest that PTEN does not regulate Rad51. Suggest that there are cases. Therefore, PARP inhibitors may be effective against many PTEN-deficient tumors, such as some aggressive prostate cancers. Cancer cells that are low in oxygen (eg, in fast-growing tumors) are sensitive to PARP inhibitors. PARP inhibitors were originally thought to work primarily by blocking PARP enzymatic activity, thereby preventing repair of DNA damage and ultimately causing cell death. PARP inhibitors have an additional mode of action: localization of PARP protein at the site of DNA damage, which is associated with anti-tumor activity. Trapped PARP protein-DNA complexes are highly toxic to cells as they block DNA replication. When researchers tested three PARP inhibitors for their differential ability to trap PARP proteins on damaged DNA, they found that the inhibitors' trapping properties varied widely. . The PARP family of proteins in humans includes PARP1 and PARP2, which are DNA binding and repair proteins. When activated by DNA damage, these proteins recruit other proteins that perform the actual work of repairing DNA. Under standard conditions, PARP1 and PARP2 are released from DNA once the repair process is underway. However, as this study shows, PARP1 and PARP2 become trapped on DNA when they bind to a PARP inhibitor. Researchers have shown that trapped PARP-DNA complexes are more toxic to cells than unrepaired single-stranded DNA breaks that accumulate in the absence of PARP activity, and PARP inhibitors act as PARP poisons. showed that These results suggest that catalytic inhibitors that act primarily to inhibit PARP enzymatic activity and do not trap PARP protein on DNA, as well as dual inhibitors that block PARP enzymatic activity and act as PARP poisons. suggested that there are two classes of PARP inhibitors: The main function of radiation therapy is to cause DNA strand breaks, causing severe DNA damage leading to cell death. Radiation therapy has the potential to kill 100% of any target cell, but the doses required to do so produce unacceptable side effects in healthy tissue. Therefore, radiation therapy is only given up to a certain level of radiation exposure. Combining PARP inhibitors with radiotherapy has the potential to be successful because the inhibitors lead to the formation of double-strand breaks from single-strand breaks produced by radiotherapy in tumor tissue with BRCA1/BRCA2 mutations. I will provide a. This combination therefore leads to a more potent treatment than with the same radiation dose, or an equally potent therapy with a lower radiation dose. Examples of PARP inhibitors include: Iniparib (BSI 201) for breast and squamous cell lung cancer; Olaparib (AZD-2281) for breast, ovarian and colorectal cancer. Rucaparib (AG014699, PF-01367338) for metastatic breast and ovarian cancer; Veliparib (ABT-888) for metastatic melanoma and breast cancer; Non-small cell lung cancer (NSCLC) MK 4827, which inhibits both PARP1 and PARP2; BMN-673 for advanced hematologic malignancies, and advanced or recurrent solid tumors; and 3-aminobenzamide.

Another family of anti-cancer targets is the PI3K/AKT/mTOR pathway. This pathway is an important signaling pathway for many cellular functions such as growth regulation, metabolism, and translation initiation. Within this pathway there are many valuable anticancer drug treatment targets and for this reason it has been the subject of much research in recent years. Phosphoinositide 3-kinase inhibitors (PI3K inhibitors) function by inhibiting the phosphoinositide 3-kinase enzyme, which is part of this pathway and thus frequently results in tumor suppression through inhibition. , is a potential medical drug. There are many different types and isoforms of PI3K. Class 1 PI3Ks have a catalytic subunit known as p110, with four types (isoforms): p110alpha, p110beta, p110gamma, and p110delta. Inhibitors under investigation inhibit one or more isoforms of class I PI3K. They are being actively investigated for the treatment of various cancers. Examples include: wortmannin, an irreversible inhibitor of PI3K; demethoxyviridine, a derivative of wortmannin; and LY294002, a reversible inhibitor of PI3K. Other PI3K inhibitors include: perifosine for colorectal cancer and multiple myeloma; CAL101, oral PI3K delta for certain late-stage leukemias; IAPL-866; IPI-145, especially Novel inhibitors of PI3K delta and gamma for hematological malignancies; BAY 80-6946, which predominantly inhibits the isoforms of PI3K alpha, delta; BEZ235, a dual PI3K/mTOR inhibitor; RP6503, for asthma and COPD. dual PI3K delta/gamma inhibitor for treatment; TGR 1202, oral PI3K delta inhibitor (also known as RP5264); SF1126, first PI3KI for B-cell chronic lymphocytic leukemia (CLL); GDC-0941 IC50 at 3 nM; BKM120; XL147 (also known as SAR245408); XL765 (also known as SAR245409); Palomid 529; ZSTK474, potent inhibitor against p110a; PWT33597- dual PI3K alpha/mTOR inhibitor for advanced solid tumors; IC87114, selective inhibitor of p110delta . It has an IC50 of 100 nM for inhibition of p110-δ; TG100-115 inhibits all four isoforms but is 5-10 fold more potent against p110-γ and p110-δ CAL263; RP6530, dual PI3K delta/gamma inhibitor for T-cell lymphoma; PI-103, dual PI3K-mTOR inhibitor; GNE-477, PI3K-alpha and mTOR with IC50 values of 4 nM and 21 nM. CUDC-907, which is also an HDAC inhibitor; and AEZS-136, which also inhibits Erk1/2.

Another anti-cancer agent is apatinib. Apatinib, also known as YN968D1, is a tyrosine kinase inhibitor that selectively inhibits vascular endothelial growth factor receptor-2 (VEGFR2, also known as KDR). It is an orally bioavailable small molecule drug that appears to inhibit angiogenesis in cancer cells; specifically, apatinib inhibits VEGF-mediated migration and proliferation of endothelial cells. , thereby blocking new blood vessel formation in tumor tissue. This drug also moderately inhibits the tyrosine kinases of c-Kit and c-SRC. Apatinib is an investigational anticancer agent currently undergoing clinical trials as a potential targeted treatment for metastatic gastric cancer, metastatic breast cancer, and advanced hepatocellular carcinoma. Cancer patients received varying doses of apatinib daily for 28 days. Apatinib is well tolerated at doses <750 mg/day, three of the three dose-limiting toxicities were reported at 1000 mg/day, and the maximum tolerated dose is measured to be 850 mg/day. The researchers also reported 65 cancer patients treated in phase I/II, 1.54% had complete responses, 12.31% had partial responses, and 66.15% were stable. had disease and 20% had progressive disease. Independent published reports on the safety and pharmacokinetics of apatinib in human clinical studies concluded that it has promising antitumor activity across a wide range of cancer types. Some cancer cells have the ability to develop resistance to the cytotoxicity of specific anticancer drugs (called multidrug resistance). The study concluded that apatinib could help circumvent multidrug resistance of cancer cells to certain conventional anticancer drugs. Studies have shown that apatinib reverses ABCB1- and ABCG2-mediated multidrug resistance by inhibiting their function and increasing intracellular concentrations of anticancer agents. This study suggests that apatinib could potentially be effective in combination with conventional anticancer agents, especially when resistance to chemotherapy exists.

Another family of anti-cancer targets is BRAF. BRAF is the human gene encoding B-Raf. The genes are also called proto-oncogenes B-Raf and v-Raf murine sarcoma virus oncogene homologous chromosome B1, while the protein is more formally known as serine/threonine-protein kinase B-Raf. there is B-Raf proteins are involved in sending signals to the interior of the cell that are involved in the orientation of cell growth. In 2002, it was shown to be defective (mutated) in human cancers. Certain other inherited BRAF mutations cause birth defects. Drugs have been developed to treat cancers controlled by BRAF. Vemurafenib and dabrafenib are approved for late-stage melanoma. B-Raf is a member of the Raf kinase family of growth signal-transducing protein kinases. This protein plays a role in regulating the MAP kinase/ERK signaling pathway, which affects cell division, differentiation, and secretion. B-Raf is a 766-amino acid, regulated signaling serine/threonine-specific protein kinase. Broadly speaking, it consists of three conserved domain features of the Raf kinase family: conserved region 1 (CR1), the Ras-GTP-binding autoregulatory domain, conserved region 2 (CR2), a serine-rich hinge region, and Conserved region 3 (CR3), the catalytic protein kinase domain that phosphorylates consensus sequences on protein substrates. In its active conformation, B-Raf forms a dimer through hydrogen bonding and electrostatic interactions of its kinase domains. B-Raf is a serine/threonine-specific protein kinase. As such, it catalyzes the phosphorylation of serine and threonine residues at consensus sequences on target proteins by ATP, resulting in ADP and phosphoproteins as products. As it is a highly regulated signaling kinase, B-Raf must first bind Ras-GTP before it becomes enzymatically active. Once B-Raf is activated, the conserved protein kinase catalytic core recruits the oxygen atom of the activated substrate serine or threonine hydroxyl on the γ-phosphate group of ATP via a bimolecular nucleophilic substitution reaction. It phosphorylates protein substrates by facilitating nuclear attack. To effectively catalyze protein phosphorylation via bimolecular substitution of serine and threonine residues with ADP as the leaving group, B-Raf first binds ATP and then γ- Since the phosphate is transferred, the transition state must be stabilized. Essentially, inhibitors of B-Raf are a common cause of cancer (see clinical significance) by over-signaling cells to grow, thereby causing active B-Raf mutants. have been developed for both inactive and active conformations of the kinase domain as therapeutic candidates for cancer. BAY43-9006 (sorafenib, Nexavar) is an FDA-approved inhibitor of the V600E mutant B-Raf and C-Raf for the treatment of early stage liver and kidney cancer. Bay43-9006 disables the B-Raf kinase domain by locking the enzyme in its inactive form. The inhibitor achieves this by blocking the ATP binding pocket through high affinity for the kinase domain. It then binds the key activation loop and DFG motif residues to stop the movement of the activation loop and DFG motif into the active conformation. Finally, the trifluoromethylphenyl moiety sterically blocks the DFG motif and the active conformational site of the activation loop, making it impossible for the kinase domain to transition conformation to activity. The distal pyridyl ring of BAY43-9006 anchors in the hydrophobic nucleotide binding pocket of the kinase N-lobe and interacts with W531, F583, and F595. Hydrophobic interactions with the catalytic loop F583 and the DFG motif F595 stabilize the inactive conformation of these structures and reduce the potential for enzyme activation. Additionally, the hydrophobic interactions of K483, L514, and T529 with the central phenyl ring increase the affinity of the kinase domain for the inhibitor. The hydrophobic interaction of F595 with the central ring likewise further reduces the energetic favourability of the DFG conformational switch. Finally, BAY43-9006's polar interaction with the kinase domain increases enzymatic affinity for inhibitors and continues this trend of stabilizing DFG residues in an inactive conformation. The E501 and C532 hydrogens link the urea and pyridyl groups of the inhibitor, respectively, while the urea carbonyl accepts a hydrogen bond from the backbone amide nitrogen of D594 to lock the DFG motif in place. By sterically blocking the hydrophobic pocket between the αC and αE helices that the DFG motif and activation loop inhabit after transitioning to their position in the active conformation of the protein. When the kinase domain is attached to BAY 43-9006, the trifluoromethylphenyl moiety cements the thermodynamic favorability of the inert conformation. PLX4032 (vemurafenib) is a V600 mutant B-Raf inhibitor approved by the FDA for the treatment of late-stage melanoma. Unlike BAY 43-9006, which inhibits the inactive form of the kinase domain, vemurafenib inhibits the active 'DFG-in' form of the kinase and anchors itself tightly at the ATP binding site. By inhibiting only the active form of the kinase, vemurafenib selectively inhibits cell proliferation through unregulated B-Raf, which normally causes cancer. The mode of action of PLX4720 is comparable to that of vemurafenib, as vemurafenib differs from its precursor (PLX4720) only in the phenyl ring added for pharmacokinetic reasons. PLX4720 is partly have excellent affinity for the ATP binding site. This allows the preservation of strong intermolecular interactions such as the N7 hydrogen bond to C532 and the N1 hydrogen bond to Q530. A good fit within the ATP-binding hydrophobic pocket (C532, W531, T529, L514, A481) increases binding affinity as well. The ketone linker hydrogen bond, which binds water and difluoro-phenyl, fits into the second hydrophobic pocket (A481, V482, K483, V471, I527, T529, L514, and F583) and overall exceptionally high binding affinity contribute to sexuality. Selective binding to active Raf is achieved by a terminal propyl group that binds to a Raf-selective pocket created by αC helix transition. The selectivity for the active conformation of the kinase is further enhanced by a pH-sensitive deprotonated sulfonamide group that is stabilized in the active state by hydrogen bonding with the backbone peptide NH of D594. In the inactive state, the inhibitor's sulfonamide group instead interacts with the backbone carbonyl group of that residue, creating repulsion. Vemurafenib therefore preferentially binds to the active state of the kinase domain of B-Raf. Mutations in the BRAF gene can cause disease in two ways. First, mutations can be inherited and cause birth defects. Mutations can then be acquired and, as oncogenes, cause cancer. Inherited mutations in this gene cause cardiofaciocutaneous syndrome, a disease characterized by heart defects, mental retardation, and a distinctive appearance. Mutations obtained in this gene have been found in cancers including non-Hodgkin's lymphoma, colorectal cancer, melanoma, papillary thyroid carcinoma, non-small cell lung cancer, and adenocarcinoma of the lung. The V600E mutation of the BRAF gene has been associated with hairy cell leukemia in numerous studies and suggested for use in screening Lynch syndrome to reduce the number of patients undergoing unnecessary MLH1 sequencing. It has been. As mentioned above, because B-Raf is a well-understood high-yielding target, some pharmaceutical companies are seeking specific inhibition of mutated B-raf protein for anticancer use. Some pharmaceutical companies are developing drugs. Vemurafenib (RG7204 or PLX4032), approved as Zelboraf for the treatment of metastatic melanoma, is an example of the current state of the art as to why active B-Raf inhibitors are being pursued as drug candidates. Vemurafenib is biochemically intriguing as a cancer-targeting mechanism because of its high potency and selectivity. B-Raf not only increased the chances of survival for patients with metastatic melanoma, but compared to the previous best chemotherapy treatment: dacarbazine, from 7-12% to 53% in the same amount of time. , increased the rate of response to treatment. Despite the drug's high efficacy, 20% of tumors still develop resistance to treatment. In mice, 20% of tumors become resistant after 56 days. Although the mechanism of this resistance is still debated, several hypotheses include high concentrations of vemurafenib and overexpression of B-Raf to compensate for upstream upregulation of proliferative signaling. More common B-raf inhibitors include GDC-0879, PLX-4720, sorafenib tosylate, dabrafenib, and LGX818.

Another family of anti-cancer agents are the MEK inhibitors. These are chemicals or drugs that inhibit the mitogen-activated protein kinase kinase enzymes MEK1 and/or MEK2. They can be used to affect the MAPK/ERK pathway, which is mostly hyperactive in some cancers. Therefore, MEK inhibitors have potential for the treatment of several cancers, particularly BRAF-mutated melanoma and KRAS/BRAF-mutated colorectal cancer. Examples of MEK inhibitors include: for the treatment of BRAF-mutated melanoma, and for possible combination with the BRAF inhibitor dabrafenib to treat BRAF-mutated melanoma. of trametinib (GSK1120212); selumetinib for non-small cell lung cancer (NSCLC); MEK162, which had Phase 1 trials for biliary tract cancer and melanoma; PD-325901; XL518; CI-1040 and PD035901.

Another family of anticancer agents are CDK (cyclin dependent kinase) inhibitors. CDK inhibitors are chemical substances that inhibit the function of CDKs. It is used to treat cancer by preventing the hyperproliferation of cancer cells. In many human cancers, CDKs are hyperactive or proteins that inhibit CDKs are not functional. Therefore, it is rational to target CDK function to prevent unregulated proliferation of cancer cells. However, genetic studies have revealed that knockout of one specific type of CDK does not frequently affect cell proliferation, or is only effective in specific tissue types, thus prompting the use of CDKs as cancer targets. efficacy should be carefully evaluated. For example, most mature cells in mice normally proliferate without both CDK4 and CDK2 present. Moreover, specific CDKs are only active during certain periods of the cell cycle. Therefore, the pharmacokinetics and dosing schedule of candidate compounds must be carefully evaluated in order to maintain active concentrations of the drug throughout the entire cell cycle. Types of CDK inhibitors include: broad-spectrum CDK inhibitors targeting a broad spectrum of CDKs; specific CDK inhibitors targeting specific types of CDKs; and VEGFR or PDGFR, etc. A number of targeted inhibitors that also target CDKs as well as additional kinases of . Specific examples include: P1446A-05, which targets CDK4 and PD-0332991, which targets CDK4 and CDK6, for leukemia, melanoma, and solid tumors.

Another anti-cancer agent is salinomycin. Salinomycin is an antibacterial and coccidiostatic ionophore therapeutic agent. Salinomycin has been shown to kill breast cancer stem cells in mice at least 100 times more effectively than the anticancer drug paclitaxel. The study screened 16,000 different chemical compounds and found that only a small subgroup, including salinomycin and etoposide, targeted cancer stem cells responsible for metastasis and recurrence. The mechanism of action of salinomycin to kill cancer stem cells remains unequivocally unknown, but may be due to its action as a potassium ionophore for detection of nigericin in the same compound screen. A study performed in 2011 showed that salinomycin can induce apoptosis of human cancer cells. In anticipation of results from a small number of clinical pilot studies, salinomycin can effectively eliminate CSCs and induce partial clinical remission in heavily pretreated and refractory cancers. to clarify. The ability of salinomycin to kill both CSC and therapy-resistant cancer cells may define the compound as a novel and effective anti-cancer agent. It has also been shown that salinomycin and its derivatives exhibit potent antiproliferative activity against drug-resistant cancer cell lines. Salinomycin is a key compound in the pharmaceutical company Verastem's efforts to produce anti-cancer stem cell drugs.

Drugs for non-small cell lung cancer may include: Abitrexate (methotrexate), Abraxane (paclitaxel albumin stabilized small particle formulation), Afatinib Dimaleate, Alimta (pemetrexed disodium), Avastin (bevacizumab), carboplatin. , cisplatin, crizotinib, erlotinib hydrochloride, Folex (methotrexate), Folex PFS (methotrexate), Gefitinib Gilotrif (afatinib dimaleate), gemcitabine hydrochloride, Gemzar (gemcitabine hydrochloride), Iressa (gefitinib), methotrexate, methotrexate LPF (methotrexate) ), Mexate (Methotrexate), Mexate-AQ (Methotrexate), Paclitaxel, Paclitaxel Albumin Stabilized Small Particle Formulation, Paraplat (Carboplatin), Paraplatin (Carboplatin), Pemetrexed Disodium, Platinol (Cisplatin), Platinol-AQ (Cisplatin) , Tarceva (erlotinib hydrochloride), Taxol (paclitaxel), and Xalkori (crizotinib).

Approved combinations for non-small cell lung cancer may include: carboplatin-taxol, and gemcitabine-cisplatin.

Drugs approved for small cell lung cancer may include: Abitrexate, Etopophos (etoposide phosphate), Etoposide, Etoposide phosphate, Folex (methotrexate), Folex PFS (methotrexate), Hycamtin (topotecan hydrochloride), methotrexate, methotrexate LPF (methotrexate), Mexate (methotrexate), Mexate-AQ (methotrexate), Toposar (etoposide), topotecan hydrochloride, and VePesid (etoposide).

Airways, including upper airways (e.g., nasal, sinus, and pharyngeal compartments), respiratory airways (e.g., laryngeal, tracheal, and bronchial compartments), and pulmonary or pulmonary compartments (e.g., respiratory bronchi, alveolar ducts, alveoli) Direct aerosol administration to one or more desired areas of the drug to obtain prodrug-active or sustained-release delivery of high and titrated concentrations of the drug to the site of respiratory pathology, Via intranasal or oral inhalation may be achieved in certain preferred embodiments (eg, “pulmonary delivery”). Aerosol administration, such as by intranasal or oral inhalation, also reduces the risk of extra-respiratory toxicities associated with non-respiratory routes of drug delivery to other tissues or organs, including, but not limited to, heart, brain, liver. prodrugs are used to provide active or sustained release delivery (e.g., further pulmonary delivery) of drugs via the pulmonary vasculature to reach the central nervous system and/or kidneys of the obtain. Thus, because the effectiveness of certain pyridone compounds (e.g., pirfenidone) therapeutic compositions can vary depending on formulation and delivery parameters, certain embodiments described herein and new delivery methods for recognized active drug compounds. Other embodiments are provided herein to diseased skin, rectum, vagina, urethra, bladder, eye, and/or ear, including, for example, aerosol delivery to burn wounds to prevent scarring. Localized pathologies and/or infections that may benefit from the discoveries described herein are contemplated through direct exposure to pirfenidone or pyridone analog compound formulations such as those described herein.

Any composition intended for therapeutic administration (such as the pirfenidone or pyridone analog compound formulations described herein) can be characterized in addition to clinical and pharmacological criteria. As such, those skilled in the art will recognize the many physico-chemical factors that are unique to a given pharmaceutical composition. These include, but are not limited to, water solubility, viscosity, partitioning coefficient (LogP), predicted stability in various formulations, osmotic pressure, surface tension, pH, pKa, pKb, dissolution rate, sputum Including permeability, sputum binding/inactivation, taste, throat irritability and acute tolerance.

Other factors to consider when selecting a particular product form are the physicochemistry of the formulation (e.g., pirfenidone or pyridone analog compound formulation), the intended disease indication for which the formulation is to be used, clinical acceptability, , and patient compliance. As a non-limiting example, aerosol delivery (e.g., by oral and/or intranasal inhalation of a mist such as a nebulized suspension of liquid particles, a dry powder formulation or an aerosol dispersion produced by a metered propellant) The desired pirfenidone or pyridone analogue compound formulation for is a simple liquid such as an aqueous liquid (e.g., an unencapsulated soluble Soluble pirfenidone or pyridone analog compounds with excipients/salts), complex liquids such as aqueous liquids (e.g. encapsulated with soluble excipients such as lipids, liposomes, cyclodextrins, microencapsulations, and emulsions) complexed or complexed pirfenidone or pyridone analog compounds), complex suspensions (e.g., as low-solubility, stable nanosuspensions alone, as co-crystal/co-precipitate complexes, and/or compounds of pirfenidone or pyridone analogues as mixtures with lipids of low solubility such as solid lipid nanoparticles), dry powders (e.g., alone or in co-crystal/co-precipitate/spray-dried complexes or low-solubility It may be provided in the form of a dry powder pirfenidone or pyridone analogue compound in a mixture with excipients/salts or readily soluble compounds such as lactose), or in the form of an organic soluble or organic suspension solution.

The selection of a particular pirfenidone or pyridone analogue compound formulation, or composition of a pirfenidone or pyridone analogue compound formulation, as provided herein in accordance with certain preferred embodiments, depends on the packaging of the desired product. depends on Factors considered in choosing packaging include, for example, inherent product stability, whether the formulation is amenable to lyophilization, device selection (e.g. liquid nebulizer, dry powder inhaler, metered dose inhaler). container), and/or packaging form (e.g., simple liquid, multiple liquid formulations), whether provided in vials as a liquid to be dissolved prior to insertion into the device or as a lyophilisate, multiple suspension formulations, whether provided in a vial as a liquid or as a lyophilate, and with or without a soluble salt/excipient component that dissolves prior to or after insertion into the device; or separate packaging of liquid and solid ingredients, dry powder formulations in vials, capsules or blister packs, and readily soluble or poorly soluble in separate containers alone or with readily soluble or poorly soluble solid medicaments. other formulations packaged as solid pharmaceutical agents.

The packaged drug has a pH of about 3.0 to about 11.0, more preferably a pH of about 4 to 8, at a concentration of at least 0.1 mg/mL to about 50 mg/mL, and a pH of at least 50 mOsmol/mL. for pulmonary delivery, including a solution provided as an aqueous solution of the pirfenidone or pyridone analog compound having a total osmolality of from kg to about 1000 mOsmol/kg, more preferably from 200 to about 500 mOsmol/kg. It may be made in such a way as to provide a composition of pirfenidone or pyridone analog compound formulation.

In some embodiments, the present invention relates to aerosol and/or topical delivery of pyridone analog compounds (eg, pirfenidone). Pirfenidone may be administered either by aerosol (e.g., via liquid nebulization, dry powder dispersion or metered administration) or topically (e.g., aqueous suspensions, oil formulations, etc., or drops, sprays, suppositories, ointments). or as an ointment) and have favorable solubility to allow administration of clinically desirable levels, acute or in subjects with or at risk of having pulmonary fibrosis It can be used in methods for prophylactic treatment. Clinical criteria for determining when pulmonary fibrosis is present or when a subject is at risk of having pulmonary fibrosis are known to those of ordinary skill in the art. Pulmonary delivery by inhalation allows direct, direct and titrated administration to the clinically desired site to reduce systemic exposure.

In a preferred embodiment, the method administers pirfenidone or pirfenidone as an aerosol (e.g., a suspension of liquid particles in air or another gas) to a subject having or suspected of having interstitial lung disease (ILD). Interstitial lung disease is treated or acts as a prophylactic against it by administering a pyridone analog compound formulation. Interstitial lung disease is defined in the International Multidisciplinary Consensus Classification of Idiopathic Interstitial Pneumonia of the American Thoracic Society/European Respiratory Society, AM. J. Respir. Crit. Care Med. 165, 277-304 (2002), including those diseases of idiopathic interstitial pneumonia. These include ILD with known causes or connective tissue disorders, occupational causes or side effects of drugs, idiopathic interstitial pneumonia (e.g. idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, exfoliative interstitial pneumonia). pneumonia, respiratory bronchiolitis-ILD, idiopathic organizing pneumonia, acute interstitial pneumonia and lymphocytic interstitial pneumonia), granulomatous lung disease (e.g. sarcoidosis, hypersensitivity stroma) pneumonia and infections), and other forms of ILD (eg, lymphangioleiomyomatosis, Langerhans' cytoosteocytosis of the lung, eosinophilic pneumonia, and alveolar proteinosis).

Methods of treatment may also include diagnostic steps, such as identifying a subject having or suspected of having ILD. In some embodiments, the method further subdivides idiopathic pulmonary fibrosis. In some embodiments, the delivered amount of an aerosol pirfenidone or pyridone analog compound (or salt thereof) formulation provides acute, subacute, or chronic symptom relief, slows the progression of fibrosis, sufficient to provide arrest of progression, reversal of fibrotic damage, and/or subsequent increase in survival and/or improvement in quality of life.

Treatment methods may also include diagnostic steps, such as identifying a subject having or suspected of having fibrosis in other tissues, by way of non-limiting example, heart, liver, kidney or skin. In some embodiments, the delivered amount of a nebulized liquid, dry powder, or metered aerosol pirfenidone or pyridone analog compound (or salt thereof) formulation provides acute, subacute, or chronic symptom relief, sufficient to slow fibrosis progression, arrest fibrosis progression, reverse fibrotic damage, and/or subsequently increase survival and/or improve quality of life.

Methods of treatment may also include diagnostic steps, such as identifying a subject having or suspected of having multiple sclerosis. In some embodiments, the delivered amount of a nebulized liquid, dry powder, or metered aerosol pirfenidone or pyridone analog compound (or salt thereof) formulation provides acute, subacute, or chronic symptom relief, sufficient to slow the progression of demyelination, arrest the progression of demyelination, reverse demyelination damage, and/or provide subsequent increased survival and/or improved quality of life.

In another embodiment, a nebulized liquid, dry powder or metered aerosol of pirfenidone or pyridone analog compound (or salt thereof) may be co-administered to also provide treatment for a coexisting bacterial infection; It can be administered continuously or can be prepared in a fixed combination with an antimicrobial agent. By way of non-limiting example, the bacterium may also be Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas acidovorans, Pseudomonas alcaligenes, Pseudomonas putida, Stenotrophomonas maltophilia, Burkholideria cepacia, Aeromonas hydrophila, Escherichia coli, Citrobacter freundii, Salmonella typhimurium, Salmonella typhi, Salmonella paratyphi, Salmonella enteritidis, Shigella disentelliae, Shigella flexneri, Shigella sonne, Enterobacter cloacae, Enterobacter erogenes, Klebsiella - Pneumonie, Klebsiella - Oxytoca, Serratia - Marcescens, Francisella - Tularensis, Morganella - Morganii, Proteus - Mirabilis, Proteus - vulgaris, Providencia - Alkalinefaciens, Providencia - Rettgeri, Providencia - Stuartii, Acinetobacter - Calcoaceticus, Acinetobacter - Acinetobacter haemolyticus, Yersinia enterocolitica, Yersinia pestis, Yersinia pseudotuberculosis, Yersinia intermedia, Bordetella pertussis, Bordetella parapertussis, Bordetella bronchiseptica, Haemophilus influenzae, Haemophilus parainfluenza , Haemophilus haemolyticus, Haemophilus parahaemolyticus, Haemophilus ducreyi, Pasteurella multocida, Pasteurella haemolytica, Branhamella catarrhalis, Helicobacter pylori, Campylobacter phytus, Campylobacter jejuni, Campylobacter coli, Borrelia burgdorferi, Vibrio cholera , Vibrio parahaemolyticus, Legionella pneumophila, Listeria monocytogenes, Neisseria gonorrhea, Neisseria meningitidis, Kingella, Moraxella, Gardnerella vaginalis, Bacteroides fragilis, Bacteroides distasonis, Bacteroides 3452A homology group, Bacteroides vulgataus, Bacteroides - Bacteroides vulgatus, Bacteroides thetaiotaomicron, Bacteroides uniformis , Bacteroides eggerii and Bacteroides splanchnicus. In some embodiments of the methods described above, the bacterium is a Gram-negative anaerobic bacterium, which by way of non-limiting example is Bacteroides fragilis, Bacteroides distasonis, Bacteroides 3452A homology group, Bacteroides vulgatus , Bacteroides vulgatus, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides eggercii and Bacteroides splanchnicus. In some embodiments of the methods described above, the bacteria are Gram-positive bacteria, which are by way of non-limiting examples Corynebacterium diphtheriae, Corynebacterium ulcerans, Streptococcus pneumoniae, Streptococcus agalactiae , Streptococcus pyogenes, Streptococcus milelli; Streptococcus (group G); Streptococcus (group C/F); , Staphylococcus intermegius, Staphylococcus hyicus subsp. hyicus, Staphylococcus haemolyticus, Staphylococcus hominis, and Staphylococcus saccharolicus. In some embodiments of the methods described above, the bacterium is a Gram-positive anaerobic bacterium, which includes, by non-limiting examples, Clostridium difficile, Clostridium perfringens, Clostridium tetini ), and Clostridium botulinum. In some embodiments of the methods described above, the bacterium is an acid-fast bacterium, which by non-limiting examples are Mycobacterium tuberculosis, Mycobacterium avium, Mycobacterium intra Including Cellularis, and Mycobacterium lepres. In some embodiments of the methods described above, the bacteria are heterotypic bacteria, which include, by non-limiting examples, Chlamydia pneumoniae and Mycoplasma pneumoniae.

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is used in epithelial lining fluid (ELF), sputum, lung tissue, bronchial lavage fluid (BAL) Provides an effective concentration or amount that results in and maintains a threshold drug concentration in the lung and/or targeted downstream tissues, which can be measured as drug concentration or by analysis of blood concentrations via pharmacokinetic analysis. For this purpose, they are formulated to allow administration as a mist, gas-liquid suspension or nebulized liquid, dry powder and/or metered dose aerosol. One embodiment is direct high concentration or titration to affected tissue for the treatment of pulmonary fibrosis in animals and humans, and inflammation associated with ILD (including idiopathic pulmonary fibrosis), COPD and asthma. including the use of aerosol administration, which results in controlled drug exposure. In one such embodiment, the peak pulmonary ELF level achieved after pulmonary aerosol administration results in a pirfenidone or pyridone analog level of between 0.1 mg/mL and about 50 mg/mL. In another embodiment, the peak wet lung tissue level achieved after pulmonary aerosol administration results in a pirfenidone or pyridone analog level of between 0.004 mcg/gram lung tissue and about 500 mcg/gram lung tissue. .

By way of non-limiting example, in a preferred embodiment, a pyridone analog compound (e.g., pirfenidone) as provided herein is used in epithelial lining fluid (ELF), sputum, lung tissue, bronchial lavage fluid (BAL) Blood and/or blood levels, which can be measured as drug levels or by analysis of blood levels via pharmacokinetic analysis, as extrapulmonary or absorbed into the pulmonary vasculature to provide sufficient drug levels for treatment, maintenance or prophylaxis. Alternatively, mists, gas-liquid suspensions or nebulized liquids, dry powders and/or metered dose aerosols can be administered to provide concentrations or amounts effective to achieve and maintain threshold drug concentrations in the lungs. It is formulated to One embodiment includes, but is not limited to, pulmonary vasculature for the treatment, maintenance and/or prevention of cardiac fibrosis, renal fibrosis, liver fibrosis, cardiac or renal toxicity, or multiple sclerosis. and the use of aerosol administration, which results in high drug exposure in the following tissues. In one such embodiment, peak tissue-specific plasma levels (e.g., cardiac , kidney and liver) or cerebrospinal fluid levels (eg, central nervous system) result in pirfenidone or pyridone analog levels between 0.1 mcg/mL and about 50 mcg/mL. In another embodiment, the peak lung wet tissue value achieved after pulmonary aerosol administration results in a pirfenidone or pyridone analog level between 0.004 mcg/gram lung tissue and about 500 mcg/gram lung tissue. .

In another embodiment, acute or prophylactic treatment of a patient via parenteral or non-nasal topical administration of a compound formulation of pirfenidone or a pyridone analogue (or salt thereof) to bring about and maintain a threshold drug concentration at a burn site. Methods for effective treatment are provided. One embodiment involves the use of aerosol administration to provide direct high-concentration drug exposure to the affected tissue for the treatment or prevention of skin scarring. For example, according to these and related embodiments, the term aerosol can include sprays, mists, or other nucleated liquid or dry powder forms.

In another embodiment, acute or prophylactic treatment of a patient via parenteral or non-nasal topical administration of a compound formulation of pirfenidone or a pyridone analogue (or salt thereof) to bring about and maintain a threshold drug concentration at a burn site. Methods for effective treatment are provided. One embodiment provides high drug exposure directly to the affected tissue for the treatment or prevention of scarring after surgical glaucoma surgery (e.g., bleb fibrosis). Including the use of aerosol administration or drops of the formulation. For example, according to these and related embodiments, the term aerosol can include sprays, mists, or other nucleated liquid or dry powder forms. Drops may be simple liquid or suspension formulations.

In another embodiment, the pyridone analog compound (e.g., pirfenidone) as provided herein is formulated by inhalation, wherein (e.g., liquid nebulization or after metered dose administration) Liquid or dry powder aerosols have a mass median aerodynamic particle size of about 1 to 10 microns and a standard geometric deviation of particle size of about 3 microns or less. In another embodiment, the particle size is a particle size with an aerodynamic mass median grain of 2 microns to about 5 microns and a geometric standard deviation of no more than about 3 microns. In one embodiment, the geometric standard deviation particle size is about 2 microns or less.

By way of non-limiting example, in preferred embodiments, pyridone analog compounds (e.g., pirfenidone) as provided herein are administered for at least about 1 minute, at least about 5 minutes, at least 10 minutes, at least 20 minutes, at least suspected pulmonary pathology for 30 minutes, at least about 1 hour, at least 2 hours, at least about 4 hours, at least 8 hours, at least 12 hours, at least 24 hours, at least 48 hours, at least 72 hours, or at least 1 week At sites of pulmonary pathology and/or pulmonary absorption into the pulmonary vasculature, therapeutically effective concentrations remain. An effective pirfenidone or pyridone analog concentration is sufficient to produce a therapeutic effect, and the effect may be localized to the site of the pulmonary pathology or may act broadly from the site of the pulmonary pathology.

By way of non-limiting example, in preferred embodiments, a pyridone analog compound (e.g., pirfenidone or a salt thereof) as provided herein after inhalation administration is administered for at least about 1 minute, at least about 5 minutes, at least 10 minutes. minutes, at least 20 minutes, at least 30 minutes, at least about 1 hour, at least 2 hours, at least about 4 hours, at least 8 hours, at least 12 hours, at least 24 hours, at least 48 hours, at least 72 hours, or for at least 1 week , cardiac fibrosis, renal fibrosis, liver fibrosis, cardiac or renal toxicity, or sites of multiple sclerosis demyelination remain therapeutically effective concentrations. An effective pirfenidone or pyridone analog concentration is sufficient to produce a therapeutic effect, and the effect may be localized to the extrapulmonary site of the condition or may act broadly from the site of the extrapulmonary condition.

In some embodiments, the pirfenidone or pyridone analog compound formulation as provided herein at a delivery site, such as a pulmonary site, is 0.1, 0.2, 0.4, 0.8 , 1, 2, 4, 6, 10, 15, 20, 25, 30, 35, 40, 45, 50 milligrams, including all integer values, of at least about 0.1 mg to about 50 mg of pirfenidone or pyridone One or more administrations are administered to achieve a daily respirable delivery dose of the analog. In some embodiments, the pirfenidone or pyridone analog compound formulations as provided herein are 0.1, 0.2, 0.4, 0.8, 1, 2, 4, 6, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140, 145, 150, 155, 160, 165, 170, 175, 180, 185, 190, 195, 200, 205, 210, 215, 220, 225, 230, 235, 240, 245, 250, 255, Daily respirable delivery of at least about 0.1 mg to about 30 mg of pirfenidone or pyridone analogs, including all integer values such as 260, 265, 270, 275, 280, 285, 290, 295, 300 milligrams. One or more administrations are administered to achieve the dosage. Pirfenidone or pyridone analog formulations for less than 60 minutes, less than 50 minutes, less than 40 minutes, less than 30 minutes, less than 20 minutes, less than 15 minutes, less than 10 minutes, less than 7 minutes, less than 5 minutes, less than 3 minutes, 2 minutes <1 minute, 10 inspiratory breaths, 8 inspiratory breaths, 6 inspiratory breaths, 4 inspiratory breaths, 3 inspiratory breaths, 2 inspiratory breaths or 1 is administered at the described respirable delivery dose on each inspiratory breath. In some embodiments, the pirfenidone or pyridone analog formulation is administered at 1 second inhalation and 2 seconds exhaling, 2 seconds inhaling and 2 seconds exhaling, 3 seconds inhaling and 2 seconds exhaling. , 4 seconds inhalation and 2 seconds exhaling, 5 seconds inhaling and 2 seconds exhaling, 6 seconds inhaling and 2 seconds exhaling, 7 seconds inhaling and 2 seconds exhaling, and The described respirable delivery dose is administered using a breathing pattern of 8 seconds inhalation and 2 seconds exhalation.

In some embodiments, the compound formulation of pirfenidone or pyridone analog (or salt thereof) at a delivery site such as a nasal cavity or sinus is 0.1, 0.2, 0.4, 0.8, 1, 2 , 4, 6, 10, 15, 20, 25, 30, 35, 40, 45, 50 milligrams, etc., of at least about 0.1 mg to about 50 mg of pirfenidone or pyridone analog daily. One or more doses are administered to achieve a deposited dose in the nasal cavity or sinuses. In some embodiments, the compound formulation of pirfenidone or pyridone analog (or salt thereof) at a delivery site such as a nasal cavity or sinus is 0.1, 0.2, 0.4, 0.8, 1, 2 , 4, 6, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120 , 125, 130, 135, 140, 145, 150, 155, 160, 165, 170, 175, 180, 185, 190, 195, 200, 205, 210, 215, 220, 225, 230, 235, 240, 245 , 250, 255, 260, 265, 270, 275, 280, 285, 290, 295, 300 milligrams, etc., of at least about 0.1 mg to about 300 mg of pirfenidone or pyridone analog daily One or more doses are administered to achieve a deposited dose in the nasal cavity or sinuses. Pirfenidone or pyridone analog formulations for less than 20 minutes, less than 15 minutes, less than 10 minutes, less than 7 minutes, less than 5 minutes, less than 3 minutes, less than 2 minutes, less than 1 minute, 10 intranasal inspiratory breaths, 8 intranasal inspiratory breaths, 6 intranasal inspiratory breaths, 4 intranasal inspiratory breaths, 3 intranasal inspiratory breaths, 2 intranasal inspiratory breaths or Administer the described nasal or sinus deposited dose in a single intranasal inspiratory breath. In some embodiments, the pirfenidone or pyridone analog formulation is administered at 1 second inhalation and 2 seconds exhaling, 2 seconds inhaling and 2 seconds exhaling, 3 seconds inhaling and 2 seconds exhaling. , 4 seconds inhalation and 2 seconds exhaling, 5 seconds inhaling and 2 seconds exhaling, 6 seconds inhaling and 2 seconds exhaling, 7 seconds inhaling and 2 seconds exhaling, 8 The described respirable delivery dose is administered using a breathing pattern of 2 seconds inhalation and 2 seconds exhalation.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human with ILD. In some embodiments, the method further subdivides idiopathic pulmonary fibrosis. In some embodiments of the methods described above, the human subject may be on a ventilator.

In embodiments where humans are ventilated, aerosol administration is performed using an in-line device (by non-limiting example, Nektar Aeroneb Pro) or similar adapter with a device for liquid nebulization. Aerosol administration can also be performed using in-line adapters for the generation and delivery of dry powder or metered dose aerosols.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of cardiac fibrosis therapy. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of renal fibrosis treatment. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of liver fibrosis treatment. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of treatment for cardiac or renal toxicity. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of COPD treatment. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of asthma treatment. In some embodiments of the methods described above, the human subject may be on a ventilator.

In some embodiments of the methods described above, the subject is human. In some embodiments of the methods described above, the subject is a human in need of multiple sclerosis treatment. In some embodiments of the methods described above, the human subject may be on a ventilator.

In another embodiment, the pharmaceutical composition is a simple liquid with unencapsulated water-soluble excipients as described above having an osmolality of from about 50 mOsmol/kg to about 6000 mOsmol/kg. Provided are compound formulations of pirfenidone or pyridone analogues (or salts thereof). In one embodiment, the osmolality is from about 50 mOsmol/kg to about 1000 mOsmol/kg. In one embodiment, the osmolality is from about 400 mOsmol/kg to about 5000 mOsmol/kg. In other embodiments, the osmolality is from about 50, 100, 150, 200, 250, 300, 350, 400, 450, 500 mOsmol/kg to about 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700 , 1800, 1900, 2000, 2200, 2400, 2600, 2800, 3000, 3200, 3400, 3600, 3800 4000, 4200, 4400, 4600, 4800, 5000, 5200, 5400, 5600, 5800 and 6000 mOsmol/kg . Osmolarity, and anywhere else in this application, "about" when used to refer to a quantitative value means that a given amount is less than or equal to the stated numerical value of 1, 2, 3, 4, It means that it can be 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 or 20 percent more or less than the stated amount.

In another embodiment, the pharmaceutical composition comprises a simple liquid pirfenidone or pyridone analogue (or salt thereof) compound formulation having an osmotic ionic concentration of between about 30 mM and about 300 mM, preferably between 50 mM and 200 mM. provided in In one such embodiment, the one or more permeant ions in the composition are selected from the group consisting of chloride and bromide.

In another embodiment, the pharmaceutical composition comprises lipids, liposomes, cyclodextrins, microencapsulations, as described above, having a solution osmolality of from about 50 mOsmol/kg to about 6000 mOsmol/kg. and multiple liquid pirfenidone or pyridone analogues (or salts thereof) compound formulations encapsulated and complexed with water-soluble excipients, such as emulsions. In one embodiment, the osmolality is from about 50 mOsmol/kg to about 1000 mOsmol/kg. In one embodiment, the osmolality is from about 100 mOsmol/kg to about 500 mOsmol/kg. In one embodiment, the osmolality is from about 400 mOsmol/kg to about 5000 mOsmol/kg.

In another embodiment, a pharmaceutical composition is provided comprising a complex liquid pirfenidone or pyridone analog (or salt thereof) compound formulation having a permeant ion concentration of from about 30 mM to about 300 mM. In one such embodiment, the one or more permeant ions in the composition are selected from the group consisting of chloride and bromide.

In another embodiment, a pharmaceutical composition is provided comprising a complex liquid pirfenidone or pyridone analog (or salt thereof) compound formulation having a permeant ion concentration of from about 50 mM to about 200 mM. In one such embodiment, the one or more permeant ions in the composition are selected from the group consisting of chloride and bromide.

In another embodiment, the pharmaceutical composition comprises about 2 pirfenidone or pyridone analog compounds to between about 0.1 to about 4 positive charges of a multivalent cation to pirfenidone or pyridone analogs to a multivalent cation. Provided are simple liquid formulations of compound formulations of pirfenidone or pyridone analogues (or salts thereof) having a positive charge molar ratio. By way of non-limiting example, two pirfenidone or pyridone analogue compounds for one magnesium ion (two cationic positive charges), three pirfenidone or pyridone analogue compounds for one magnesium ion, one magnesium ion four pirfenidone or pyridone analog compounds for each magnesium ion and two pirfenidone or pyridone analog compounds for two magnesium ions.

An unexpected finding was that a divalent cation, by way of non-limiting example, magnesium decreased the dissolution time of pirfenidone and increased the aqueous solubility of pirfenidone in a molar ratio dependent manner. This increased saturated solubility allows for the delivery of predictably sufficient amounts of inhaled liquid nebulized pirfenidone to the lungs. By way of example, one pirfenidone molecule to three magnesium molecules showed a slower dissolution time and reduced saturation solubility than one pirfenidone molecule to one magnesium molecule. Furthermore, one pirfenidone molecule to one magnesium molecule showed a faster dissolution time and greater aqueous solubility than an equimolar ratio of pirfenidone to sodium.

In another embodiment, the pharmaceutical composition comprises a pirfenidone or pyridone analogue (or a salt thereof) having a pirfenidone or pyridone analogue for positive charges of from about 0.1 to about 4 multivalent cations. Provided include multiple liquid formulations of compound formulations. By way of non-limiting example, two pirfenidone or pyridone analogue compounds for one magnesium ion (two cationic positive charges), three pirfenidone or pyridone analogue compounds for one magnesium ion, one magnesium ion four pirfenidone or pyridone analog compounds for each magnesium ion and two pirfenidone or pyridone analog compounds for two magnesium ions.

In another embodiment, the pharmaceutical composition, alone or co-crystal/co-precipitate, as described above, has a solution osmolality of from about 50 mOsmol/kg to about 6000 mOsmol/kg. Compound formulations of complex liquid pirfenidone or pyridone analogues (or salts thereof) as stable nanosuspensions of low water solubility in mixtures with low solubility lipids, such as lipid nanosuspensions. provided. In one embodiment, the osmolality is from about 100 mOsmol/kg to about 500 mOsmol/kg. In one embodiment, the osmolality is from about 400 mOsmol/kg to about 5000 mOsmol/kg.

In another embodiment, a pharmaceutical composition is provided comprising a complex suspension of a pirfenidone or pyridone analog (or salt thereof) compound formulation having a permeant ion concentration of from about 30 mM to about 300 mM. be. In one such embodiment, the one or more permeant ions in the composition are selected from the group consisting of chloride and bromide.

In another embodiment, a pharmaceutical composition is provided comprising a complex suspension of a pirfenidone or pyridone analog (or salt thereof) compound formulation having a permeant ion concentration of from about 50 mM to about 200 mM. be. In one such embodiment, the one or more permeant ions in the composition are selected from the group consisting of chloride and bromide.

In another embodiment, the pharmaceutical composition comprises about one pirfenidone or pyridone analog compound to between about 0.1 to about 4 positive charges of a multivalent cation to pirfenidone or pyridone analog to multivalent cations. A complex suspension of compound formulations of pirfenidone or pyridone analogues (or salts thereof) having a positive charge molar ratio is provided. By way of non-limiting example, two pirfenidone or pyridone analogue compounds for one magnesium ion (two cationic positive charges), three pirfenidone or pyridone analogue compounds for one magnesium ion, one magnesium ion four pirfenidone or pyridone analog compounds for each magnesium ion and two pirfenidone or pyridone analog compounds for two magnesium ions.

In other embodiments, a pirfenidone or pyridone analog (or salt thereof) compound formulation, or pharmaceutical composition, as provided herein is provided comprising a flavoring agent. As non-limiting examples, flavoring agents include sugars, saccharin (e.g., sodium saccharin), sweeteners, or to beneficially affect taste, aftertaste, perceived unpleasant saltiness, sourness, or bitterness, or (e.g., delivery oral medications that irritate the recipient (such as by causing cough or pharyngitis or other unwanted side effects), which can reduce dosage or adversely affect patient compliance with prescribed treatment regimens Or it may contain other compounds or agents that reduce the tendency of the formulation to be inhaled. Certain flavoring agents may form complexes with compounds that are pirfenidone or pyridone analogs (or salts thereof).

In certain preferred embodiments relating to the pirfenidone or pyridone analog (or salt thereof) compound formulations disclosed herein, the formulation comprises the pirfenidone or pyridone analog (or salt thereof) compound and a flavoring agent. , desired osmotic pressure, and/or optimized osmotic ion concentration. In certain such embodiments, the flavoring agent comprises saccharin (eg, sodium saccharin), which, according to non-limiting theory, may have little or no effect on the detectable osmotic pressure of the solution. In addition, it offers certain advantages related to the ability of this flavor masking agent to provide desirable taste effects even when present in very low concentrations, whereby the formulations described herein are well tolerated. The method can deliver aqueous solutions, organic formulations or dry powder formulations. In certain such embodiments, the flavoring agent comprises a chelating agent (e.g., a divalent cation such as EDTA or magnesium), which, according to non-limiting theory, is a chemical compound that stimulates taste on pirfenidone or pyridone analogs. Part masking provides certain advantages related to the ability of this flavoring agent to provide desirable taste effects. Along with divalent cations, inclusion as a taste masking agent can also substitute as an osmotic agent, and pending salt forms can also provide permeant ions (e.g., magnesium chloride), thereby enhancing the present invention. The formulations described herein are capable of delivering aqueous, organic or dry powder formulations in a well tolerated manner. Non-limiting examples of these and related embodiments herein include aqueous solutions having a pH of about 4 to about 8 and an osmotic pressure of about 50 to about 1000 mOsmol/kg (e.g., adjusted with sodium chloride). A pirfenidone or pyridone analogue (or salt thereof) compound formulation for pulmonary delivery as described in , wherein the aqueous solution comprises a pirfenidone or pyridone analogue (or salt thereof) compound and sodium saccharin, wherein The aqueous solution contains about 0.1 mM to about 2.0 mM saccharin. A related non-limiting example further includes citrate (eg, citric acid) in an aqueous solution containing about 1 mM to about 100 mM citrate. A related non-limiting example further includes or replaces citrate with phosphate (eg, sodium phosphate) in an aqueous solution containing about 0.0 mM to about 100 mM phosphate. Another related, non-limiting example is the addition of citrate in an aqueous solution containing about 0.5 mM to about 100 mM phosphate, or replacing citrate with phosphate (e.g., sodium phosphate). do. By way of another non-limiting example, these and related embodiments comprise an aqueous solution having a pH of about 4 to about 8 and an osmotic pressure of about 50 to about 5000 mOsmol/kg (e.g., adjusted with magnesium chloride), A pirfenidone or pyridone analogue (or salt thereof) compound formulation for pulmonary delivery as described herein, wherein the aqueous solution comprises a pirfenidone or pyridone analogue (or salt thereof) compound, wherein In , divalent cations (eg, beryllium, magnesium, or calcium) function to regulate osmotic pressure and as taste masking agents. When included as a flavoring agent, the divalent cation (eg, magnesium) is added stoichiometrically with the pirfenidone or pyridone analogue. For example, 1 mol of divalent ion for 2 mol of pirfenidone or pyridone analogue, 1.5 mol of divalent ion for 2 mol of pirfenidone or pyridone analogue, 2 mol of pirfenidone or pyridone analogue to 2 mol of divalent ion. ions, 3 mol of divalent ions per 2 mol of pirfenidone or pyridone analogues or 4 mol of divalent ions per 2 mol of pirfenidone or pyridone analogues. Sodium chloride or additional divalent salts can be used if the osmotic pressure needs to be further increased. A related non-limiting example further includes citrate (eg, citric acid) in an aqueous solution containing about 1 mM to about 100 mM citrate. A related non-limiting example is citrate exchange with phosphate (eg, sodium phosphate) in an aqueous solution containing about 0.0 mM to about 100 mM phosphate. Another related, non-limiting example is citrate exchange with phosphate (eg, sodium phosphate) in an aqueous solution containing about 0.0 mM to about 100 mM phosphate.

In another embodiment, the inclusion of the correct molar ratio of magnesium to pirfenidone reduces the dissolution time and increases the saturation solubility to levels required for sufficient liquid nebulization delivery to the lungs, an unexpected discovery. was that this formulation additionally required a flavoring agent for acute tolerance after inhalation of the nebulized solution. For this purpose, between 0.1 and 1.0 micromolar saccharin allows the use of formulations that allow this solubility.

In another embodiment, pharmaceutical compositions may be protected from light to avoid photodegradation.
By way of non-limiting example, this can occur in light-protected vials, ampoules, blisters, capsules or other colored or light-protected primary packaging. By way of another non-limiting example, this can occur through the use of secondary packaging such as aluminum or other light-protected over-pouches, boxes or other secondary packaging.

In another embodiment, pharmaceutical compositions may be protected from oxygen to protect against oxidation. By way of non-limiting example, in solution, this may be accomplished by removing oxygen from the solution prior to or during mixing (e.g., sparging) and/or controlling the headspace gas of the primary packaging (e.g., use of an inert gas such as argon or nitrogen in the headspace). Similarly, by way of another non-limiting example, control of contained secondary packaging gases (eg, with inert gases) may also be required. For powder formulations this can be controlled by the use of an insertion gas in the primary and/or secondary packaging. Metered dose products may benefit by the same means as described above for solution products.

In another embodiment, the pirfenidone or pyridone analogue in the pharmaceutical composition can be protected from hydrolysis by including a cationic metal ion. By way of non-limiting example, acid hydrolysis of amide bonds decreases as salt concentration increases. Specifically, the hydration number is important in reducing this rate, as electrolyte hydration reduces the availability of free water for the reaction. Therefore, the rate decreases with increasing salt and hydration number. The order of increasing hydration number is potassium<sodium<lithium<magnesium. Velocity reduction is also roughly analogous to ionic strength. By way of non-limiting example, the addition of magnesium stabilizes the 2-pyridone structure of pirfenidone. Pirfenidone is known to chelate Fe(III) at a ratio of 3 pirfenidone molecules to 1 Fe(III). From this it follows that pirfenidone chelates magnesium with 2 pirfenidone molecules for 1 magnesium + 2 charges. Thus, for this purpose, the addition of metal ions of magnesium or other cations can be in direct proportion to the amount of pirfenidone or pyridone analogues. By way of non-limiting example, 2 pirfenidone molecules for 0.1 magnesium molecules, 2 pirfenidone molecules for 0.25 magnesium molecules, 2 pirfenidone molecules for 0.5 magnesium molecules, 0.75 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 1.5 magnesium molecules, 2 pirfenidone molecules for 2 magnesium molecules, 3 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 4 magnesium molecules, 2 pirfenidone molecules for 5 magnesium molecules, 2 pirfenidone molecules for 6 magnesium molecules, 7 magnesium 2 pirfenidone molecules per molecule, 2 pirfenidone molecules per 8 magnesium molecules, 2 pirfenidone molecules per 9 magnesium molecules, 2 pirfenidone molecules per 10 magnesium molecules, 12 magnesium molecules 2 pirfenidone molecules for 14 magnesium molecules, 2 pirfenidone molecules for 16 magnesium molecules, 2 pirfenidone molecules for 18 magnesium molecules, or 2 pirfenidone molecules for 20 magnesium molecules. There are two pirfenidone molecules. Potassium, sodium, lithium or iron can be substituted for magnesium in these ratios and pharmaceutical compositions. The above pharmaceutical compositions include maintenance of the buffers described herein at a pH of from about 4.0 to about 8.0, the buffers having a pH of 300 mOsmo/kg and 600 mOsmo/kg. MgCl2 or its cationic salt at a level that provides osmotic pressure. 300 mOsmo/kg has been discussed in the literature as important for this post-inhalation acute tolerance in nebulized solutions, but 600 mOsmo/kg is well tolerated with other drug solutions in unpublished studies. has been shown in However, final solution osmolarities of up to 6000 mOsmo/kg are contemplated. Unexpectedly, the formulations described herein demonstrate excellent tolerance at high osmotic pressures.

In another embodiment, the liquid pirfenidone or pyridone analog pharmaceutical compositions may contain a solubility enhancer or co-solvent. By way of non-limiting example, these may include ethanol, cetylpyridinium chloride, glycerin, lecithin, propylene glycol, polysorbates (including polysorbates 20, 40, 60, 80 and 85), sorbitan trioleate, and the like. By further example, cetylpyridinium chloride may be used from about 0.01 mg/mL to about 4 mg/mL of the pharmaceutical composition. Similarly, by way of another non-limiting example, ethanol can be used from about 0.01% to about 30% of the pharmaceutical composition. Similarly, by way of another non-limiting example, glycerin can be used from about 0.01% to about 25% of the pharmaceutical composition. Similarly, by way of another non-limiting example, lecithin can be used from about 0.01% to about 4% of the pharmaceutical composition. Similarly, by way of another non-limiting example, propylene glycol may be used from about 0.01% to about 30% of the pharmaceutical composition. Similarly, by way of another non-limiting example, polysorbate can also be used from about 0.01% to about 10% of the pharmaceutical composition. Similarly, by way of another non-limiting example, sorbitan trioleate can be used from about 0.01% to about 20% of the pharmaceutical composition.

In another embodiment, a liquid or dry powder pirfenidone or pyridone analog pharmaceutical composition may contain a chelated metal ion to aid in the solubility and/or dissolution of the pirfenidone or pyridone analog. By way of non-limiting example, these may include iron, magnesium, or calcium.

In another embodiment, the liquid or dry powder pirfenidone or pyridone analog pharmaceutical compositions may contain chelated metal ions to aid in scavenging reactive oxygen species. By way of non-limiting example, these may include iron, magnesium, or calcium. By way of non-limiting example, for this purpose the addition of metal ions of magnesium or other cations can be in direct proportion to the amount of pirfenidone or pyridone analogues. By way of non-limiting example, 2 pirfenidone molecules for 0.1 magnesium molecules, 2 pirfenidone molecules for 0.25 magnesium molecules, 2 pirfenidone molecules for 0.5 magnesium molecules, 0.75 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 1.5 magnesium molecules, 2 pirfenidone molecules for 2 magnesium molecules, 3 2 pirfenidone molecules for 1 magnesium molecule, 2 pirfenidone molecules for 4 magnesium molecules, 2 pirfenidone molecules for 5 magnesium molecules, 2 pirfenidone molecules for 6 magnesium molecules, 7 magnesium 2 pirfenidone molecules per molecule, 2 pirfenidone molecules per 8 magnesium molecules, 2 pirfenidone molecules per 9 magnesium molecules, 2 pirfenidone molecules per 10 magnesium molecules, 12 magnesium molecules 2 pirfenidone molecules for each, 2 pirfenidone molecules for 14 magnesium molecules, 2 pirfenidone molecules for 16 magnesium molecules, 2 pirfenidone molecules for 18 magnesium molecules, or 20 magnesium molecules for are two pirfenidone molecules. Potassium, sodium, lithium or iron can be substituted for magnesium in these ratios and pharmaceutical compositions. The above pharmaceutical compositions include maintenance of the buffers described herein at a pH of from about 4.0 to about 8.0, the buffers having a pH of 300 mOsmo/kg and 600 mOsmo/kg. _MgCl2 or its cationic salt at a level that provides osmotic pressure. 300 mOsmo/kg has been discussed in the literature as important for this post-inhalation acute tolerance in nebulized solutions, but 600 mOsmo/kg is well tolerated with other drug solutions in unpublished studies. has been shown in However, final solution osmolarities of up to 5000 mOsmo/kg are contemplated.

In some embodiments, described herein are pharmaceutical compositions comprising pirfenidone; water; phosphate or citrate buffer; and optionally sodium chloride or magnesium chloride. water; buffer; and selected from sodium chloride, magnesium chloride, ethanol, propylene glycol, glycerol, polysorbate 80, and ethylpyridinium chloride bromide (or chloride). Pharmaceutical compositions are described that include at least one additional ingredient. In some embodiments, the buffer is phosphate buffer. In other embodiments, the buffer is citrate buffer. In some embodiments, the pharmaceutical composition comprises 1 mg to 500 mg pirfenidone, such as 5 mg, 10 mg, 15 mg, 25 mg, 37.5 mg, 75 mg, 100 mg, 115 mg, 150 mg, 190 mg, 220 mg, or 500 mg pirfenidone. In some embodiments, the osmotic pressure of the pharmaceutical compositions described herein is between about 50 mOsmo/kg and 6000 mOsmo/kg. In some embodiments, the pharmaceutical composition optionally includes saccharin (eg, sodium salt). Non-limiting examples of pharmaceutical compositions described herein include any one of the pharmaceutical compositions described in Example 1, Tables 1-1 through 1-11.

Solutions of pirfenidone should remain protected from light due to the susceptibility of the API in solution to degradation.

In another embodiment, the pharmaceutical composition comprises a simple dry powder pirfenidone or pyridone analogue (or salt thereof) compound alone in dry powder form, with or without additives such as lactose. provided inclusive.

In another embodiment, the pharmaceutical composition for use in a liquid, dry powder or metered dose inhaler is provided such that the pirfenidone or pyridone analog is not in salt form.

In another embodiment, the pharmaceutical composition comprises a low water-soluble excipient in a co-crystal/co-precipitate/spray dry complex or in dry powder form, with or without additives such as lactose. Compound formulations of compound dry powder pirfenidone or pyridone analogs (or salts thereof) are provided in mixtures with formulations/salts.

In another embodiment, a system for administering a pirfenidone or pyridone analogue (or salt thereof) compound is provided, the system comprising a container comprising a solution of a pirfenidone or pyridone analogue (or salt thereof) compound formulation , and a mean mass aerodynamic diameter, volume mean diameter (VMD), or mass physically associated with or packaged with the container and having a mean mass aerodynamic diameter of about 1 micron to about 5 microns. A nebulizer suitable for producing an aerosol of a solution having a particle size with a median diameter (MMD) and a geometric standard deviation of the aerodynamic diameter of mean mass of less than or equal to about 2.5 microns. In one embodiment, the geometric standard deviation particle size is less than or equal to about 3.0 microns. In one embodiment, the geometric standard deviation particle size is less than or equal to about 2.0 microns.

In another embodiment, a system for administering a dry powder of a pirfenidone or pyridone analogue (or salt thereof) compound is provided, the system comprising a container comprising the pirfenidone or pyridone analogue (or salt thereof) compound. , and a dispersed dry powder bound to a container and having a particle size with an average mass aerodynamic diameter of from about 1 micron to about 5 microns and a particle size with a standard deviation of no more than about 3.0 microns Includes dry powder inhalers suitable for generating aerosols. In one embodiment, the standard deviation of particle size is less than or equal to about 2.5 microns. In one embodiment, the standard deviation of particle size is less than or equal to about 2.0 microns.

In another embodiment, the kit includes a container comprising a pharmaceutical formulation comprising a compound of pirfenidone or a pyridone analogue (or salt thereof) and aerosolizing the pharmaceutical formulation and administering it to the lower respiratory tract, e.g., the lungs, after oral administration. Suitable for delivery to pulmonary compartments such as alveoli, alveolar ducts and/or bronchioles are provided comprising an aerosolizer (eg, in certain preferred embodiments, a liquid nebulizer). Formulations may also be delivered as a dry powder or via a metered dose inhaler.

In another embodiment, the kit comprises a container comprising a pharmaceutical formulation comprising a pirfenidone or pyridone analog (or salt thereof) compound and a method for aerosolizing the pharmaceutical formulation and delivering it to the nasal cavity following intranasal administration. A suitable aerosolizer (eg, in certain preferred embodiments, a liquid atomizer) is provided. Formulations may also be delivered as a dry powder or via a metered dose inhaler.

It is understood that many carriers and excipients may serve some function, even within the same formulation.

Contemplated pharmaceutical compositions provide a therapeutically effective amount of the pirfenidone or pyridone analogue compound, which allows, for example, once-daily, twice-daily, thrice-daily, etc. administration. In some embodiments, the pharmaceutical composition for delivery by inhalation provides an effective amount of the pirfenidone or pyridone analog compound to allow once-daily dosing. In some embodiments, the pharmaceutical composition for delivery by inhalation provides an effective amount of the pirfenidone or pyridone analog compound to allow administration twice daily. In some embodiments, the pharmaceutical composition for delivery by inhalation provides an effective amount of the pirfenidone or pyridone analog compound to allow administration three times daily.

It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention as claimed.

<Specific terminology>
The term "mg" refers to milligrams.

The term "mcg" refers to micrograms.

The term "microM" refers to micromolar.

The term "QD" refers to once daily dosing.

The term "BID" refers to twice daily dosing.

The term "TID" refers to three times daily dosing.

The term "QID" refers to administration four times a day.

As used herein, the term "about" is used synonymously with the term "approximately." Illustratively, use of the term “about” in relation to a particular therapeutically effective dose means that that value differs slightly from the quoted value, e.g. indicate.

As used herein, the terms "comprising," "including," "such as," and "for example" are used in their broad, non-limiting sense. be.

The terms "administration" or "administering" and "delivery" or "delivery" are used to describe, for example, anti-inflammatory, anti-fibrotic and/or anti-demyelinating A dose of a therapeutic or prophylactic formulation, such as a pirfenidone or pyridone analogue (or salt thereof) compound formulation described herein, as a pharmaceutical composition or for other purposes, in a mammal. refers to the method of giving to The preferred method of delivery or administration depends on various factors such as the components of the pharmaceutical composition, the desired site to which the formulation is introduced, delivered or administered, the site where therapeutic effect is desired, or a downstream diseased organ. (e.g., aerosol delivery to the lung for absorption and second delivery to the heart, kidney, liver, central nervous system, or other diseased site). . In some embodiments, the pharmaceutical compositions described herein are administered by pulmonary administration.

The terms "pulmonary administration", "inhalation" or "pulmonary delivery" or "oral inhalation" or "intranasal inhalation" and other related terms is a therapeutic agent, such as a compound formulation of pirfenidone or a pyridone analogue (or salt thereof) described herein, by a route such that the desired therapeutic or prophylactic agent is delivered to the lungs of a mammal. Refers to a method of administering a dose of the above or prophylactic formulation to a mammal. Such delivery to the lung can occur by intranasal administration, oral inhalation administration. Each of these routes of administration can occur as an inhalation of an aerosol of the formulations described herein. In some embodiments, pulmonary administration occurs by passively delivering an aerosol described herein by a ventilator.

The terms "intranasal inhalation administration" and "intranasal inhalation delivery" mean that the formulation targets delivery and absorption of a therapeutic formulation directly in the lungs of a mammal through the nasal passages. Refers to a method of providing a mammal with a dosage of a therapeutic or prophylactic formulation, such as a pirfenidone or pyridone analogue (or salt thereof) compound formulation described herein, by a route as described herein. In some embodiments, intranasal inhalation administration is performed by a nebulizer.

The terms "intranasal administration" and "intranasal delivery" refer to the delivery of a desired therapeutic or prophylactic agent to the nasal passages or downstream diseased organs (e.g., central nervous system or intranasal delivery). aerosol delivery to the nasal cavity for absorption and secondary delivery to other diseased loci), such as pirfenidone or pyridone analogues (or salts thereof) compound formulations described herein; of a therapeutic or prophylactic formulation to a mammal. Such delivery to the nasal cavity can occur by intranasal administration, where the routes of administration are inhalation of an aerosol of the formulations described herein, injection of an aerosol of the formulations described herein, It can occur as a gavage of the formulations described herein, or as passive delivery via a ventilator.

The terms "intraocular administration" and "intraocular delivery" are described herein by a route such that the desired therapeutic or prophylactic agent is delivered to the eye. Refers to a method of providing a mammal with a dosage of a therapeutic or prophylactic formulation, such as a compound formulation of pirfenidone or a pyridone analogue (or salt thereof). Such delivery to the eye can occur by direct administration to the eye. This route of administration can occur as a spray of an aerosol of the formulations described herein, an infusion of an aerosol of the formulations described herein, or a drop of the formulations described herein.

"Oral administration" or "orally" or "oral" is a route of administration by which a substance (eg, a pharmaceutical composition) is obtained through the oral cavity. In some embodiments, it, when used without any further description, refers to administration of a substance directly through the oral cavity to the gastrointestinal tract. Oral administration generally includes many forms such as tablets, pills, capsules, and solutions.

The term "oral inhalation administration" or "oral inhalation delivery" or "oral inhalation" refers to a formulation for delivery and absorption directly to the lungs of a mammal. Refers to a method of administering a dose of a therapeutic or prophylactic formulation, such as a pirfenidone or pyridone analogue (or salt thereof) compound formulation described herein, to a mammal through the oral cavity. In some embodiments, oral inhalation administration is accomplished through the use of a nebulizer.

The term "abnormal liver function" can manifest as abnormal levels of biomarkers of liver function, including alanine transaminase, aspartate transaminase, bilirubin, and/or alkaline phosphatase, and drug-induced liver injury. can be an indicator of FDA Draft Guidance for Industry. See Drug-Induced Liver Injury: Premarketing Clinical Evaluation, October 2007.

"Grade 2 liver function abnormalities" are levels of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase >2.5 times and <5 times the upper limit of normal (ULN) (ALP), or elevated gamma-glutamyltransferase (GGT). Grade 2 liver dysfunction also includes elevated bilirubin levels greater than 1.5 and less than or equal to 3 times the ULN.

"Gastrointestinal adverse events" include, but are not limited to, any one or more of the following: dyspepsia, nausea, diarrhea, gastroesophageal reflux disease (GERD) and vomiting.

A “carrier” or “excipient” is a chemical compound or substance used to facilitate administration of the compound, eg, to increase the solubility of the compound. Solid carriers include, for example, starch, lactose, dicalcium phosphate, sucrose, and kaolin. Liquid carriers include, for example, sterile water, saline, buffers, nonionic surfactants, and edible oils such as oil, peanut and sesame oils. Additionally, various adjuvants as commonly used in the art may be included. These and other such compounds are described in the literature, eg, Merck Index, Merck & Company, Rahway, NJ. A discussion of the inclusion of various ingredients in pharmaceutical compositions can be found, for example, in Gilman et al. (Eds.) (1990); Goodman and Gilman's: The Pharmacological Basis of Therapeutics, 8th Ed. , Pergamon Press.

A "diagnostic" as used herein is a compound, method, system or device that aids in the identification and characterization of a state of health or disease. Diagnostics can be used in standard assays, as known in the art.

"Patient" or "subject" are used interchangeably and refer to mammals.

The term "mammal" is used in its normal biological sense. In some embodiments, the mammal is human.

The term "ex vivo" refers to experiments or manipulations performed in or on living tissue in an artificial environment other than an organism.

The term "pharmaceutically acceptable carrier" or "pharmaceutically acceptable excipient" includes any and all solvents, dispersion media, coating agents, antibacterial and bactericidal agents, isotonic and absorption and absorption delaying agents. The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions.

The term "pharmaceutically acceptable salt" refers to salts that retain the biological effectiveness and properties of the compounds of this invention, which are not biologically or otherwise undesirable. otherwise undesirable). In many cases, the compounds of the invention are capable of forming acids and/or base salts due to the presence of amino and/or carboxyl groups or groups similar thereto. Pharmaceutically acceptable acid addition salts can be formed with inorganic and organic acids. Inorganic acids from which salts can be derived include, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like. Organic acids that can be derived from salts are, for example, acetic acid, propionic acid, naphthoic acid, oleic acid, palmitic acid, pamonic acid (embonic acid), stearic acid, glycolic acid, pyruvic acid, oxalic acid, maleic acid, malonic acid, Succinic acid, fumaric acid, tartaric acid, citric acid, ascorbic acid, glucopeptonic acid, glucuronic acid, lactic acid, lactobionic acid, tartaric acid, benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonic acid, p-toluenesulfone Including acid, salicylic acid, etc. Pharmaceutically acceptable base addition salts can be formed with inorganic and organic bases. Inorganic bases that can be derived from salts include, for example, sodium, potassium, lithium, ammonium, calcium, magnesium, iron, zinc, copper, manganese, aluminum, etc., with ammonium, potassium, sodium, calcium and magnesium salts being particularly preferred. . Organic bases that can be derived from salts include, for example, primary, secondary, and tertiary amines, substituted amines including naturally occurring substituted amines, cyclic amines, basic ion exchange resins, In particular, it includes isopropylamine, trimethylamine, diethylamine, triethylamine, tripropylamine, histidine, arginine, lysine, benetamine, N-methyl-glucamine, and ethanolamine. Other acids include dodecylsulfuric acid, naphthalene-1,5-disulfonic acid, naphthalene-2-sulfonic acid, and saccharin.

The term "pH-reducing acid" refers to an acid that retains the biological efficacy and properties of the compounds of the invention, which is not biologically or otherwise undesirable. . Pharmaceutically acceptable pH-lowering acids include, for example, inorganic acids such as hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like. Also by way of non-limiting example, acids that lower pH are also citric acid, acetic acid, propionic acid, naphthoic acid, oleic acid, palmitic acid, pamonic acid (embonic acid), stearic acid, glycolic acid, pyruvic acid, oxalic acid, Maleic acid, malonic acid, succinic acid, fumaric acid, tartaric acid, citric acid, ascorbic acid, glucopeptonic acid, glucuronic acid, lactic acid, lactobionic acid, tartaric acid, benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfone Organic acids such as acids, p-toluenesulfonic acid, salicylic acid, and the like may be included.

According to certain embodiments disclosed herein, pirfenidone or pyridone analog compound formulations may include an "acidic excipient" typically present as an aqueous acidic excipient solution. Examples are acid salts such as phosphates, sulfates, nitrates, acetates, formates, citrates, tartrates, propionates and sorbates; carboxylic acids, sulfonic acids, phosphonic acids, phosphinic acids; organic acids such as acid monoesters and phosphoric diesters and/or 1 to 12 carbon atoms, citric, acetic, formic, propionic, butyric, benzoic, monochloroacetic, dichloroacetic and trichloroacetic acids, salicylic acid, Other organic acids may be included, including trifluoroacetic acid, benzenesulfonic acid, toluenesulfonic acid, methylphosphonic acid, methylphosphinic acid, dimethylphosphinic acid, and phosphonic acid monobutyl ester.

"Buffer" refers to a compound that functions to regulate pH. In certain related embodiments, pH buffers are present under conditions and in sufficient amounts to maintain a pH that is "about" a specified pH value. "About" such pH refers to the functional presence of the buffer, which, as is known in the art, includes the buffer's pKa value, buffer concentration, processing temperature, pKa ( That is, the buffer is at an equilibrium state between the protonated and deprotonated forms, typically the center of the effective buffering range of pH values. It can be the result of a variety of factors, including the effects of ingredients, and other factors.

Thus, "about" in the context of pH is 0.5 pH units or less, more preferably 0.4 pH units or less, more preferably 0.3 pH units or less, even more preferably 0.5 pH units or less. It can be understood to represent a quantitative variation in pH that can be greater or less than the specified value by no more than 2 pH units, most preferably no more than 0.1-0.15 pH units. As indicated above, in certain embodiments, a substantially constant pH (e.g., a pH maintained within a specified range for an extended period of time) is from about pH 4.0 to about pH 8.0. , from about pH 4.0 to about pH 7.0, or from about pH 4.0 to about pH 6.8, or any other pH or pH range as described herein, which In a preferred embodiment, the pH may be from about 4.0 to about 8.0 for the pirfenidone or pyridone analog compound formulation, and may be greater than pH 8.0 for the aqueous solution of the pirfenidone or pyridone analog compound.

Thus, pH buffers typically, when present under appropriate conditions and in sufficient amounts, maintain a desired pH level as can be selected by one skilled in the art. citrate, formate, malate, formate, pyridine, piperazine, succinate, histidine, maleate, bis-tris, pyrophosphate, PIPES, ACES, histidine, MES, cacodyl acid, H ₂ CO ₃ /NaHCO ₃ and N-(2-acetamido)-2-iminodiacetic acid (ADA), or a desired compound of pirfenidone or pyridone analogs based on the disclosure herein. may contain other buffers to maintain, preserve, enhance, protect, or promote the biological or pharmacological activity of Suitable buffers may include those in Table 1 or known in the art (e.g. Calbiochem® Biochemicals & Immunochemicals Catalog 2004/2005, pp. 68-69 and catalog pages cited therein, See EMD Biosciences, La Jolla, Calif.).

Non-limiting examples of buffers that may be used in accordance with certain embodiments disclosed herein include, but are not limited to, formate (pKa 3.77), citric acid (pKa2 4.76), malate (pKa2 5.13), pyridine (pKa 5.23), piperazine ((pKa1) 5.33), succinate ((pKa2) 5.64), histidine (pKa 6.04), maleate ((pKa2) 6.04). 24), citric acid ((pKa3) 6.40), bis-tris (pKa 6.46), pyrophosphate ((pKa3) 6.70), PIPES (pKa 6.76), ACES (pKa 6.78 ), histidine (pKa 6.80), MES (pKa 6.15), cacodylic acid (pKa 6.27), H ₂ CO ₃ /NaHCO ₃ (pKa1) (6.37), ADA (N-(2- Acetamido)-2-iminodiacetic acid) (pKa 6.60). In some embodiments, pharmaceutical compositions disclosed herein comprise citrate or phosphate buffers. In some embodiments, pharmaceutical compositions disclosed herein comprise a citrate buffer. In some embodiments, pharmaceutical compositions disclosed herein comprise a phosphate buffer.

"Solvate" refers to a compound formed by the interaction of a solvent with a pirfenidone or pyridone analog compound, metabolite, or salt thereof. Suitable solvates are pharmaceutically acceptable solvates, including hydrates.

By "therapeutically effective amount" or "pharmaceutically effective amount" is intended a pirfenidone or pyridone analog compound, as disclosed with respect to the present invention, that has a therapeutic effect. The amount of pirfenidone or pyridone analog compound useful for treatment is that amount which is therapeutically effective. Thus, as used herein, a therapeutically effective amount is based on clinical trial results and/or model animal pulmonary fibrosis, cardiac fibrosis, renal fibrosis, liver fibrosis, cardiac or renal toxicity, It means that amount of the pirfenidone or pyridone analog compound that produces the desired therapeutic effect as judged by multiple sclerosis, COPD or asthma. In a specific embodiment, the pirfenidone or pyridone analog compound is administered at a predetermined dosage, and thus the therapeutically effective amount is the amount of the dosage administered. This amount and the amount of the pirfenidone or pyridone analogue compound can be routinely determined by those skilled in the art to produce a therapeutic or prophylactic effect against fibrotic, inflammatory, demyelinating damage, etc. and how far the diseased site is from the initial breathing position to receive the initial inhaled aerosol dose. This amount is further dependent on the patient's height, weight, sex, age and medical history. For prophylactic treatment, a therapeutically effective amount is an amount that will be effective in preventing fibrotic, inflammatory or demyelinating injury.

A "therapeutic effect" reduces, to some extent, one or more of the symptoms associated with inflammation, fibrosis and/or demyelination. This includes slowing the progression of, preventing or reducing further inflammation, fibrosis and/or demyelination. For IPF, "treatment effect" is defined as patient-reported improvement in quality of life and/or statistically significant increase or stabilization of exercise stress test and related blood oxygen saturation, baseline forced vital capacity Defined as decreased decline, decreased incidence of acute exacerbations, increased progression-free survival, increased time-to-death or disease improvement, and/or decreased pulmonary fibrosis. With respect to cardiac fibrosis, "therapeutic benefit" is a patient-reported improvement in quality of life and/or a statistically significant Defined as reduction or reversal, reduction in arrhythmia incidence, and/or reduction in atrial or ventricular remodeling. For renal fibrosis, "therapeutic effect" is defined as a patient-reported improvement in quality of life and/or a statistically significant improvement in glomerular filtration rate and related markers. With respect to liver fibrosis, "therapeutic effect" includes patient-reported improvement in quality of life and/or statistically significant aminotransferase (e.g., AST and ALT), alkaline phosphatase, gamma-glutamyltransferase, bilirubin, prothrombin time , defined as reversal of thrombocytopenia, leukopenia and neutropenia and coagulopathy, in addition to reduction of elevated globulin. In addition, potential reversal of imaging, endoscopic or other pathological findings. For COPD, "treatment effect" is defined as patient-reported improvement in quality of life and/or statistically significant improvement in exercise capacity and related blood oxygen saturation, FEV1 and/or FVC, similar, no Defined as slowing or halting the progression of exacerbation survival, increasing longevity or improving disease, and/or reducing the incidence of acute exacerbations. With respect to asthma, a "therapeutic effect" is a patient-reported improvement in quality of life and/or a statistically significant improvement in exercise capacity, an improvement in FEV1 and/or FVC, and/or a reduction in the incidence of acute exacerbations. defined as For multiple sclerosis, "treatment effect" is defined as patient-reported improvement in quality of life and/or statistically significant improvement in Scripps Neurological Rating Scale score, improvement in bladder dysfunction, improvement in Disability Status Scores. , MRI lesion count, and/or delay or arrest of disease progression.

"Treat," "treatment," or "treating," as used herein, refers to administering a pharmaceutical composition for therapeutic purposes. . In some embodiments, treating reduces, alleviates, or ameliorates at least one symptom of a disease or condition, prevents any further symptoms from occurring, or treats at least one current symptom of a disease or condition. Relieve at least one of the diseases or symptoms of the disease, cause regression of the disease or disease, relieve the disease or the disease caused by the disease or the disease, or stop the disease or the symptoms of the disease. In some embodiments, the compositions described herein are used for prophylactic treatment. The term "prophylactic treatment" refers to the pharmaceutical compositions described herein that are not already afflicted with the disease but are susceptible to or otherwise at risk of or afflicted with a particular disease. refers to treating patients whose symptoms do not worsen while being treated with The term "therapeutic treatment" refers to administering treatment to a patient already afflicted with a disease. Thus, in a preferred embodiment, treating is administration to a mammal (for therapeutic or prophylactic purposes) of a therapeutically effective amount of a pirfenidone or pyridone analog compound.

"Treat," "treatment," or "treating," as used herein, refers to administering a pharmaceutical composition for prophylactic and/or therapeutic purposes. The term "prophylactic treatment" refers to treating a patient who is not already ill, but who is predisposed or otherwise at risk for a particular disease. The term "therapeutic treatment" refers to administering treatment to a patient already afflicted with a disease. Thus, in a preferred embodiment, treating is administration to a mammal (for therapeutic or prophylactic purposes) of a therapeutically effective amount of a pirfenidone or pyridone analog compound.

The term "dosing interval" refers to the time between administration of two consecutive doses of a pharmaceutical agent in a multiple dosing regimen.

A “respirable delivered dose” is an amount of aerosolized pirfenidone or pyridone analog compound particles inhaled during the inspiratory phase of a respiratory simulator that is 5 microns or less.

"Pulmonary deposition" as used herein refers to a small nominal dose of an active pharmaceutical ingredient (API) that is deposited on the inner surface of the lungs.

"Nominal dose" or "loaded dose" refers to the amount of drug placed in the nebulizer prior to administration to a mammal. The amount of solution containing the nominal dose is called the "fill volume."

"Enhanced pharmacokinetic properties" means an improvement in some pharmacokinetic parameter. Pharmacokinetic parameters that may be improved include AUC _last , AUC _(0-∞), T _max , and optionally C _max . In some embodiments, the enhanced pharmacokinetic properties improve the pharmacokinetic parameters obtained for a nominal dose of active pharmaceutical ingredient (API) administered by one type of inhalation device. , can be quantitatively determined by comparison with the same pharmacokinetic parameters obtained by oral administration of the same active pharmaceutical ingredient (API) composition.

"Plasma concentration" refers to the concentration of an active pharmaceutical ingredient in the plasma component of the blood of a subject or patient population.

"Respiratory disease" as used herein includes, but is not limited to, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), bronchitis, chronic bronchitis, emphysema, or asthma. Refers to a disease or illness that is physically manifested in the respiratory tract.

"Nebulizer," as used herein, refers to a device that transforms medicaments, compositions, formulations, suspensions, mixtures, etc. into a nebulized mist or aerosol for delivery to the lungs. . A nebulizer may also be referred to as an atomizer.

"Drug absorption" or simply "absorption" typically refers to the passage of drug from the site of delivery (e.g., drug absorbed into the pulmonary capillary bed of the alveoli) across the barrier to the blood vessel or site of action. Refers to the process of movement of

<Pirfenidone and Pyridone Analog Compounds>
As indicated elsewhere herein, in preferred embodiments, the pyridone compound for use in the formulation of the pyridone compound as described herein is pirfenidone (5-methyl-1-phenyl -2-(1H)-pyridone) or salts thereof. Although various embodiments are described with the use of pirfenidone, it is noted that other pyridone analog compounds, or salts thereof, can be used in place of pirfenidone.

Pirfenidone, also known as 5-methyl-1-phenyl-2-(1H)-pyridone, has the following structure:

A "pyridone analog" or "pyridone compound" refers to a compound that has the same type of biological activity and efficacy as pirfenidone. Such pyridone analogue compounds are compounds that provide anti-inflammatory, anti-fibrotic and/or demyelinating activity for therapeutic or prophylactic purposes after administration to a mammal. be. In some embodiments, the pyridone analog is a compound having a substituted 2-(1H)pyridone or 3-(1H)pyridone core structure. In some embodiments, the pyridone analog is a compound having a substituted 2-(2h)pyridone core structure.

1-phenyl-2-(1H)pyridone, 5-methyl-1-(4-methylphenyl)-2-(1H)-pyridone, 5-methyl-1-(4-hydroxyphenyl)-2-(1H) -pyridone, 5-methyl-1-(4-methoxyphenyl)-2-(1H)-pyridone, 5-methyl-1-(2'-pyridyl)-2-(1H)pyridone, 6-methyl-1- Phenyl-3-(1H)pyridone, 6-methyl-1-phenyl-2-(1H)pyridone, 5-methyl-1-p-tolyl-3-(1H)pyridone, 5-methyl-3-phenyl-1 -(2'-thienyl)-2-(1H)pyridone, 5-methyl-1-(2'-naphthyl)-3-(1H)pyridone, 5-methyl-1-(2'-naphthyl)-2- (1H)pyridone, 5-methyl-1-phenyl-3-(1H)pyridone, 5-methyl-1-p-tolyl-2-(1H)pyridone, 5-methyl-1-(1'naphthyl)-2 -(1H)pyridone, 5-methyl-1-(5′-quinolyl)-3-(1H)pyridone, 5-ethyl-1-phenyl-2-(1H)pyridone, 5-ethyl-1-phenyl-3 -(1H)pyridone, 5-methyl-1-(5'-quinolyl)-2-(1H)pyridone, 5-methyl-1-(4'-methoxyphenyl)-3-(1H)pyridone, 5-methyl -1-(4′-quinolyl)-2-(1H)pyridone, 4-methyl-1-phenyl-3-(1H)pyridone, 5-methyl-1-(4′-pyridyl)-2-(1H) pyridone, 5-methyl-1-(3'-pyridyl)-3-(1H)pyridone, 3-methyl-1-phenyl-2-(1H)pyridone, 5-methyl-1-(4'-methoxyphenyl) -2-(1H)pyridone, 5-methyl-1-(2′-thienyl)-3-(1H)pyridone, 5-methyl-1-(2′-pyridyl)-3-(1H)pyridone, 1, 3-diphenyl-2-(1H)pyridone, 1,3-diphenyl-5-methyl-2-(1H)pyridone, 5-methyl-1-(2′-quinolyl)-3-(1H)pyridone, 5- Methyl-1-(3'-trifluoromethylphenyl)-2-(1H)pyridone, 1-phenyl-3-(1H)pyridone, 1-(2'-furyl)-5-methyl-3-(1H) -pyridone, 3-ethyl-1-phenyl-2-(1H)pyridone, 1-(4'-chlorophenyl)-5-methyl(1H)pyridone, 5-methyl-1-(3'-pyridyl)-2- 3-(1H) pyridone , 5-methyl-1-(3-nitrophenyl)-2-(1H)pyridone, 3-(4′-chlorophenyl)-5-methyl-1-phenyl-2-(1H)pyridone, 5-methyl-1 -(2'-thienyl)-2-(1H)pyridone, 5-methyl-1-(2'-thiazolyl)-2-(1H)pyridone, 3,6-dimethyl-1-phenyl-2-(1H) pyridone, 1-(4'-chlorophenyl)-5-methyl-2-(1H)pyridone, 1-(2'-imidazolyl)-5-methyl-2-(1H)pyridone, 1-(4'-nitrophenyl) -2-(1H)pyridone, 1-(2'-furyl)-5-methyl-2-(1H)pyridone, 1-phenyl-3-(4'-chlorophenyl)-2-(1H)pyridone.

In some embodiments, the pyridone analog compounds are listed in U.S. Patent Publication No. US20090005424; U.S. Patent Publication No. 20070092488; U.S. Patent No. 8,022,087; , 716,632; U.S. Patent No. 5,518,729; U.S. Patent No. 5,310,562; U.S. Patent No. 4,052,509; , 839,346; or US Pat. No. 3,974,281.

In some embodiments, the pyridone analog is a deuterated pirfenidone compound in which one or more hydrogen atoms of pirfenidone are replaced with deuterium.

According to certain other different embodiments of the compositions and methods described herein, the pyridone compound is bis(2-hydroxyethyl)azanium; 2-(3,5-diiodo-4-oxopyridine-1- yl)acetic acid, propyl 2-(3,5-diiodo-4-oxopyridin-1-yl)acetic acid, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl][1,2 ,4]triazolo[4,3-a]pyridin-3-one hydrochloride], 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1,2,4]triazolo [4,3-a]pyridin-3-one, 3-anilino-1-phenylpropan-1-one, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1 ,2,4]triazolo[4,3-a]pyridin-3-one hydrochloride, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1,2,4] Triazolo[4,3a]pyridin-3-one, 2S)-2-amino-3-(3-hydroxy-4-oxopyridin-1-yl)propanoic acid, 2-[3-[4(3-chlorophenyl) Piperazin-1-yl]propyl]-[1,2,4]triazolo[4,3-a]pyridin-3-one, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl ]-[1,2,4]triazolo[4,3-a]pyridin-3-one hydrochloride, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1, 2,4]triazolo[4,3-a]pyridin-3-one hydrochloride, (2S)-2-[(3-hydroxy-4-oxopyridin-1-yl)amino]propanoic acid, 2-[3 -[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1,2,4]triazolo[4,3-a]pyridin-3-one hydrochloride, 2-amino-3-(3- Hydroxy-4-oxopyridin-1-yl)propanoic acid, 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1,2,4]triazolo[4,3-a] Pyridin-3-one hydrochloride, propyl 2-(3,5-diiodo-4-oxopyridin-1-yl)acetic acid, 2-(3,5-diiodo-4-oxopyridin-1-yl)acetic acid;2 -(2-hydroxyethylamino)ethanol, (2S)-2-amino-3-(3-hydroxy-4-oxopyridine-1 -yl)propanoic acid, (2R)-2-amino-3-(3-hydroxy-4-oxopyridin-1-yl)propanoic acid, 2-amino-3-(3-hydroxy-4-oxopyridine-1 -yl)propanoic acid, 5-cyano-6-methyl-N-[4(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3- Carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-5-nitro-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5 -(1-butoxyvinyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxy Amido, 5-acetyl-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5 -[(1E)-N-methoxyethanimidoyl]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2 -dihydropyridine-3-carboxamide, 5-[(1E)-N-hydroxyethanimidoyl]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoro methyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-5-(pyridin-3-ylethynyl)-1-[3- (Trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-5-(2-pyridin-3-ylethynyl)- 1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(tri fluoromethyl)phenyl]-5-vinyl-1,2-dihydropyridine-3-carboxamide, ethyl 2-methyl-5-({[4-(methylsulfonyl)benzyl]amino}carbonyl)-6-oxo-1-[ 3-(trifluoromethyl)phenyl]-1,6-dihydropyri Dine-3-carboxylate, 5-(4-methanesulfonyl-benzylcarbamoyl)-2-methyl-6-oxo-1-(3-trifluoromethyl-phenyl)-1,6-dihydro-pyridine-3- Carboxylic acid, 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 5-dimethylamide 3-(4-methanesulfonyl-benzyl amide), 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 5-amide 3-(4-methanesulfonyl-benzylamide ), 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 3-(4-methanesulfonyl-benzylamide) 5-methylamide , 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 5-[(2-hydroxy-ethyl)-methyl-amide] 3-(4-methanesulfonyl-benzylamide), 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 3-(4 -methanesulfonyl-benzylamido) 5-(methyl-propyl-amido), 6-methyl-2-oxo-5-(pyrrolidine-1-carbonyl)-1-(3-trifluoromethyl-phenyl)-1,2 -dihydro-pyridine-3,5-dicarboxylic acid 3-(4-methanesulfonyl-benzylamide), 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine -3,5-dicarboxylic acid 5-[(2-dimethylamino-ethyl)-methyl-amide] 3-(4-methanesulfonyl-benzylamide), 5-((2R)-2-hydroxymethyl-pyrrolidine-1 -carbonyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 3-(4-methanesulfonyl-benzylamide), 5- (3-hydroxy-pyrrolidine-1-carbonyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 3-(4 -methanesulfonyl-benzylamide), N ³ -[(1,1- Dioxido-2,3-dihydro-1-benzothien-5-yl)methyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2- Dihydropyridine-3,5-dicarboxamide, 5-(N ¹ -acetyl-hydrazinocarbonyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine- 3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-[N ¹ -(2-cyano-acetyl)-hydrazinocarbonyl]-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl) -1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-{[2-(aminocarbonothioyl)hydrazino]carbonyl}-6-methyl-N-[4-(methylsulfonyl) ) benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-hydrazinocarbonyl-6-methyl-2-oxo-1-(3- trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-({2-[(ethylamino)carbonyl]hydrazino}carbonyl)-6-methyl-N -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-({2-[(N,N- dimethylamino)carbonyl]hydrazino}carbonyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3 -carboxamide, 5-(3,3-dimethyl-ureido)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methane Sulfonyl-benzylamide, 6-methyl-5-(3-methyl-ureido)-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methane sulfonyl-benzylamide, 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-5-ureido-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-amino-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 6-methyl-N- [4-(methylsulfonyl)benzyl]-2-oxo-5-propionyl-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-formyl-6-methyl-N -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl) ) benzyl]-2-oxo-5-(3-oxobutyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-acetyl-N-[4-(isopropyl sulfonyl)benzyl]-6-methyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-acetyl-1-(3-cyano-phenyl)- 6-methyl-2-oxo-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-acetyl-1-(3-chloro-phenyl)-6-methyl-2-oxo- 1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-acetyl-6-methyl-2-oxo-1-m-tolyl-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-(1-hydroxyethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]- 1,2-dihydropyridine-3-carboxamide, 5-(1-azidoethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl] -1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-5-(1-morpholin-4-ylethyl)-2-oxo-1-[3-(tri fluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(1-hydroxypropyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3- (Trifluoromethyl)phenyl le]-1,2-dihydropyridine-3-carboxamide, 5-(1-hydroxyethyl)-N-[4-(isopropylsulfonyl)benzyl]-6-methyl-2-oxo-1-[3-(trifluoro Methyl)phenyl]-1,2-dihydropyridine-3-carboxamide, N-[4-(cyclopropylsulfonyl)benzyl]-5-formyl-6-methyl-2-oxo 1-[3-(trifluoromethyl)phenyl ]-1,2-dihydropyridine-3-carboxamide, 5-[(E)-(methoxyimino)methyl]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3 -(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(hydroxymethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3 -(Trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-[(dimethylamino)methyl]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1 -[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-5-[(methylamino)methyl]-N-[4-(methylsulfonyl)benzyl]-2- oxo 1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-5-(morpholin-4-ylmethyl)- 2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-{[(2-furylmethyl)amino]methyl}-6-methyl-N-[4 -(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-[(cyclopropylamino)methyl]-6-methyl- N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-{[(2-hydroxypropyl)amino ]methyl}-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-[ (cyclo pliers amino)methyl]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5- {[(2-hydroxyethyl)(methyl)amino]methyl}-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1 , 2-dihydropyridine-3-carboxamide, 6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-5-(pyrrolidin-1-ylmethyl)-1-[3-(trifluoromethyl)phenyl ]-1,2-dihydropyridine-3-carboxamide, 5-{[methoxy(methyl)amino]methyl}-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3- (Trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-{[(cyanomethyl)amino]methyl}-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo- 1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-{[(cyclopropylmethyl)amino]methyl}-6-methyl-N-[4-(methylsulfonyl) benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-[(3-hydroxypyrrolidin-1-yl)methyl]-6-methyl- N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(2-hydroxyethoxy)-N- [4-(isopropylsulfonyl)benzyl]-6-methyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 2-methyl-5-({[ 4-(methylsulfonyl)benzyl]amino}carbonyl)-6-oxo-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridin-3-ylacetic acid, 5-methoxy-6-methyl-N -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(3-methoxypropoxy)-6-methyl -N-[4-(methyls ruphonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 2-methyl-5-({[4-(methylsulfonyl)benzyl]amino }carbonyl)-6-oxo-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridin-3-yl methanesulfonic acid, 5-ethoxy-6-methyl-N-[4-(methylsulfonyl ) benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(2-hydroxyethoxy)-6-methyl-N-[4-( methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(cyanomethoxy)-6-methyl-N-[4-( methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 2-({2-methyl-5-({[4-(methyl Sulfonyl)benzyl]amino}carbonyl)-6-oxo-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridin-3-yl}oxy)ethyl acetate, 5-[2-(dimethylamino) -2-oxoethoxy]-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 5-(2-aminoethoxy)-N-[4-(isopropylsulfonyl)benzyl]-6-methyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3- Carboxamide, 5-(acetylamino)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3- Carboxamide, N-[4-(isopropylsulfonyl)benzyl]-6-methyl-5-[3-(methylamino)propoxy]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2 -dihydropyridine-3-carboxamide, 5-(1-methoxyethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1 , 2-dihydropyridine-3-cal Boxamide, 5-(2-bromo-1-methoxyethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1, 2-dihydropyridine-3-carboxamide, 5-(1-isopropoxyethyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl] -1,2-dihydropyridine-3-carboxamide, 5-(N ¹ -isobutyryl-hydrazinocarbonyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro- Pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, N ⁵ -methoxy-6-methyl-N ³ -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl) Phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ -methoxy-N ⁵ ,6-dimethyl-N ³ -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3 -(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, 5-[(2,5-dimethyl-2,5-dihydro-1H-pyrrol-1-yl)carbonyl]-6 -methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-N ³ -[ 4-(methylsulfonyl)benzyl]-2-oxo-N ⁵ -pyrrolidin-1-yl-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, 6- Methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-5-(piperidin-1-ylcarbonyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3- Carboxamide, 6-methyl-N ³ -[4-(methylsulfonyl)benzyl]-N ⁵ -morpholin-4-yl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine -3,5-dicarboxamide, 6-methyl-5-[(4-methylpiperidin-1-yl)carbonyl]-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-( trifluoromethyl)phenyl]-1,2- Dihydropyridine-3-carboxamide, 6-methyl-N ³ -[4-(methylsulfonyl)benzyl]-2-oxo-N ⁵ -piperidin-1-yl-1-[3-(trifluoromethyl)phenyl]-1 ,2-dihydropyridine-3,5-dicarboxamide, N ⁵ -(tert-butyl)-N ⁵ ,6-dimethyl-N ³ -[4-(methylsulfonyl)benzyl]-2-oxo-1-[3- (trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ -butyl-N ⁵ ,6-dimethyl-N ³ -[4-(methylsulfonyl)benzyl]-2-oxo- 1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ -ethyl-N ⁵ -isopropyl-6-methyl-N ³ -[4-(methylsulfonyl) benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, 5-[N ¹ -(formyl-hydrazinocarbonyl]-6-methyl -2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, N ¹ -[5-(4-methanesulfonyl-benzyl Carbamoyl)-2-methyl-6-oxo-1-(3-trifluoromethyl-phenyl)-1,6-dihydro-pyridine-3-carbonyl]-hydrazinecarboxylic acid ethyl ester, 5-({2-[( Ethylamino)carbonothiol]hydrazino}carbonyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine -3-carboxamide, 5-(isoxazolidin-2-ylcarbonyl)-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]- 1,2-dihydropyridine-3-carboxamide, 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 5-(methoxy-methyl -amido)3-[4-(propane-2-sulfonyl)-benzylamide], 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyri Dine-3,5-dicarboxylic acid 3-(4-ethanesulfonyl-benzylamide) 5-(methoxy-methyl-amide), 6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1 ,2-dihydro-pyridine-3,5-dicarboxylic acid 3-(4-cyclopropanesulfonyl-benzylamide) 5-(methoxy-methyl-amide), 6-methyl-2
-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3,5-dicarboxylic acid 5-[(2-hydroxy-ethyl)-amide]3-(4-methanesulfonyl- benzylamide, 5-(isoxazolidine-2-carbonyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)1,2-dihydro-pyridine-3-carboxylic acid 4-ethanesulfonyl- benzylamide, 5-(isoxazolidine-2-carbonyl)-6-methyl-2-oxo-1-(3-trifluoromethylphenyl)1,2 dihydropyridine-3-carboxylic acid 4-cyclopropanesulfonylbenzylamide, 5 -(N-hydroxycarbamimidoyl)-6-methyl-2-oxo-1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide , N ³ -(cyclohexylmethyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(pyridin-3-ylmethyl)-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide , N ⁵ ,N ⁵ ,6-trimethyl-N ³ -(2-morpholin-4-ylethyl)-2-oxo-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3, 5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-N ³ -(3-morpholin-4-ylpropyl)-2-oxo-1-[3-(trifluoromethyl)-phenyl]-1,2 -dihydropyridine-3,5-dicarboxamide, N ³ -benzyl-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydro-pyridine- 3,5-dicarboxamide, N ³ -[2-(1H-indol-3-yl)ethyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)- Phenyl]-1,2-dihydro-pyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(1-phenylethyl)-1-[3-(trifluoro methyl)phenyl le]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(2-phenylethyl)-1-[3-(trifluoromethyl) Phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -[(2R)-2-phenylcyclopropyl]-1-[3- (Trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(2,3-dihydro-1H-inden-2-yl)-N ⁵ ,N ⁵ ,6-trimethyl -2-oxo-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -[2-(1,3-benzodioxole-5- yl)ethyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, 5-{[4 -(2-Hydroxyethyl)piperazin-1-yl]carbonyl}-N,N,2-trimethyl-6-oxo-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridine-3-carboxamide , N ³ -[(1-ethylpyrrolidin-2-yl)methyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine -3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-N ³ -[3-(2-methylpiperidin-1-yl)propyl]-2-oxo-1-[3-(trifluoromethyl ) phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-N ³ -(1-naphthylmethyl)-2-oxo-1-[3-(trifluoromethyl ) phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(1,3-benzodioxol-5-ylmethyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1 -[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(3,4-difluorobenzyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo -1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5- Dicarboxamide, N ³ -(2-chloro-4-fluorobenzyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine -3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(2-thienylmethyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine -3,5-dicarboxamide, N ³ -(3,4-dichlorobenzyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2 -dihydropyridine-3,5-dicarboxamide, N ³ -[2-(2,4-dichlorophenyl)ethyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl) -phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(2-cyclohex-1-en-1-ylethyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1- [3-(Trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -[1-(4-chlorophenyl)ethyl]-N ⁵ ,N ⁵ ,6-trimethyl-2 -oxo-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -[3- (2-oxopyrrolidin-1-yl)propyl]-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2 -oxo-N ³ -(pyridin-4-ylmethyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N,N,2-trimethyl-6- Oxo-5-[(4-phenylpiperazin-1-yl)carbonyl]-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridine-3-carboxamide, N,N,2-trimethyl-6 -oxo-5-[(4-pyridin-2-ylpiperazin-1-yl)carbonyl]-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridine-3-carboxamide, N ³ -( 2,3-dihydro-1-benzofuran-5-ylmethyl) -N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, methyl 4-{[({5- [(dimethylamino)carbonyl]-6-methyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridin-3-yl}carbonyl)amino]methyl}benzoate, 5- {[3-(dimethylamino)pyrrolidin-1-yl]carbonyl}-N,N,2-trimethyl-6-oxo-1-[3-(trifluoromethyl)phenyl]-1,6-dihydropyridine-3- Carboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -[2-(2-thienyl)ethyl]-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3 ,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(4-phenoxybenzyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3 ,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -(3-thienylmethyl)-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3 ,5-dicarboxamide, N ³ -[2-(4-tert-butylphenyl)ethyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)-phenyl] -1,2-dihydropyridine-3,5-dicarboxamide, N ³ -{2-[4-(aminosulfonyl)phenyl]ethyl}-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3 -(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -[4-(1H-pyrazol-1-yl ) benzyl]-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -phenoxy- 1-[3-(trifluoromethyl)phenyl]-1,2-dihydro-pyridine-3,5-dicarboxamide, N ³ -(2,3-dihydro-1,4-benzodioxin-2-ylmethyl)- N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3- (trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -[(6-fluoro-4H-1,3-benzodioxin-8-yl)methyl]-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(1-benzothien-3-ylmethyl)-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)-phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl- 2-oxo-N ³ -[2-(tetrahydro-2H-pyran-4-yl)ethyl]-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-N ³ -[(1-methyl-1H-pyrazol-4-yl)methyl]-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2 -dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-N ³ -[(1-phenyl-1H-pyrazol-4-yl)methyl]-1-[3-( trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -[(5-methoxy-4-oxo-4H-pyran-2-yl)methyl]-N ⁵ , N ⁵ , 6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(3-azepan-1-ylpropyl)-N ⁵ , N
^5,6 -trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ³ -(4-cyanobenzyl)-N ⁵ ,N ^5,6 -trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5-dicarboxamide, N ⁵ ,N ⁵ ,6-trimethyl-2-oxo- N ³ -[3-(5-oxo-4,5-dihydro-1H-pyrazol-4-yl)propyl]-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3,5 -dicarboxamide, N ³ -{[(2R)-1-ethylpyrrolidin-2-yl]methyl}-N ⁵ ,N ⁵ ,6-trimethyl-2-oxo-1-[3-(trifluoromethyl)phenyl ]-1,2-dihydropyridine-3,5-dicarboxamide, 5-cyclopropyl-6-methyl-N-[4-(methylsulfonyl)benzyl]-2-oxo-1-[3-(trifluoromethyl) Phenyl]-1,2-dihydropyridine-3-carboxamide, 6-methyl-5-(2-methyl-1,3-dioxolan-2-yl)-N-[4-(methylsulfonyl)benzyl]-2-oxo -1-[3-(trifluoromethyl)phenyl]-1,2-dihydro-pyridine-3-carboxamide, 5-(4,5-dihydro-oxazol-2-yl)-6-methyl-2-oxo- 1-(3-trifluoromethyl-phenyl)-1,2-dihydro-pyridine-3-carboxylic acid 4-methanesulfonyl-benzylamide, 5-cyclopropyl-6-methyl-N-{[5-(methylsulfonyl ) pyridin-2-yl]methyl}-2-oxo-1-[3-(trifluoromethyl)phenyl]-1,2-dihydropyridine-3-carboxamide, 2-amino-3-(3-hydroxy-4- oxopyridin-1-yl)propanoic acid, (2S)-2-amino-3-(3-hydroxy-4-oxopyridin-1-yl)propanoic acid, 2-amino-3-(3-hydroxy-4- oxopyridin-1-yl)propanoic acid, (2S)-2-amino-3-(3-hydroxy-4-oxopyridin-1-yl)propanoic acid, 2-amino-3-(3-hydroxy-4- oxopyridin-1-yl)propanoic acid, 2-amino-3-(3-hydroxy-4-oxopyridin-1-yl)propanoic acid acid, propyl 2-(3,5-diiodo-4-oxopyridin-1-yl)acetic acid, (2S)-2-azaniumyl-3-(3-hydroxy-4-oxopyridin-1-yl)propanoate, Propyl 2-(3,5-diiodo-4-oxopyridin-1-yl)acetic acid, 2-(4-aminophenyl)ethanol, 4-hydroxy-5-(3-methylanilino)-1H-pyrimidin-6-one , 6-cyclohexyl-1-hydroxy-4-methylpyridin-2-one, 1,6-dimethyl-2-oxo-5-pyridin-4-ylpyridine-3-carbonitrile, (2-oxo-1H-pyridine- 3-yl)acetic acid, 3-methyl-1-(2,4,6-trimethylphenyl)butan-1-one, 5-methyl-1-phenylpyridin-2-one, 6-cyclohexyl-1-hydroxy-4 -methylpyridin-2-one, 2-aminoethanol; 6-cyclohexyl-1-hydroxy-4-methylpyridin-2-one, 4-[(3,5-diiodo-4-oxopyridin-1-yl)methyl ] benzoic acid, 2-aminoethanol; 3-[(6-hydroxy-5-methyl-2-oxo-1H-pyridin-3-yl)imino]-5-methylpyridine-2,6-dione, 5-ethyl -3-[(5-ethyl-2-methoxy-6-methylpyridin-3-yl)methylamino]-6-methyl-1H-pyridin-2-one, 6-cyclohexyl-1-hydroxy-4-methylpyridine -2-one, 5-(2,5-dihydroxyphenyl)-1H-pyridin-2-one, 6-(4,4-dimethyl-5-oxofuran-2-yl)-1H-pyridin-2-one, N′-(6-oxo-1H-pyridin-2-yl)-N,N-dipropylmethanimidamide, [6-oxo-1-[(2R,3R,4S,5S,6R)-3,4 , 5-trihydroxy-6-(hydroxylmethyl)oxan-2-yl]pyridin-2-yl]acetic acid, 5-(2,5-dihydroxyphenyl)-1H-pyridin-2-one, 3-[(6 -hydroxy-5-methyl-2-oxo-1H-pyridin-3-yl)imino]-5-methylpyridine-2,6-dione, 5-(4-cyanophenyl)-6-methyl-2-oxo- 1H-pyridine-3-carbonitrile, 3,3-diethyl-1-[(piperazin-1-ylamino)methyl]pyridine-2,4-dione, 5-ethyl-3-[(5-ethyl- 2-Methoxy-6-methylpyridin-3-yl)methylamino]-6-methyl-1H-pyridin-2-one and pharmaceutically acceptable salts thereof.

In some embodiments, the pirfenidone or pyridone analog compounds are used in the compositions and methods described herein in their free base or free acid form. In other embodiments, the pirfenidone or pyridone analog compounds are used as pharmaceutically acceptable salts. In some embodiments, pharmaceutically acceptable salts are obtained by reacting a compound with an acid or base. Types of pharmaceutically acceptable salts include, but are not limited to, the free base of a compound with a pharmaceutically acceptable such as (1) hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, metaphosphoric acid, acetic acid, Propionic acid, hexanoic acid, cyclopentanepropionic acid, glycolic acid, pyruvic acid, lactic acid, malonic acid, succinic acid, malic acid, maleic acid, fumaric acid, trifluoroacetic acid, tartaric acid, citric acid, benzoic acid, 3-(4) -hydroxybenzoyl)benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonic acid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid, toluenesulfonic acid, 2-naphthalenesulfonic acid, 4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid, glucopeptonic acid, 4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid, 3- Pharmaceutically acceptable such as phenylpropionic acid, trimethylacetic acid, tertiary butylacetic acid, lauryl sulfate, gluconic acid, glutamic acid, hydroxynaphthoic acid, salicylic acid, stearic acid, muconic acid, butyric acid, phenylacetic acid, phenylbutyric acid, valproic acid or (2) acidic protons present in the parent compound are converted by metal ions such as alkali metal ions (e.g. lithium, sodium, potassium), alkaline earth ions (e.g. magnesium or calcium), or aluminum ions. In some cases, pirfenidone or pyridone analog compounds include, but are not limited to, ethanolamine, diethanolamine, tri It is reacted with organic bases such as ethanolamine, tromethamine, N-methylglucamine, dicyclohexylamine, tris(hydroxymethyl)methylamine, or with amino acids such as, but not limited to, arginine, lysine.

Advantages of inhaled aerosol and topical (parenteral) drug delivery
Inhalation therapy of aerosolized pirfenidone or pyridone analog compounds to the respiratory tract (intranasal or pulmonary) for deposition to areas immediately downstream of the site of vascular absorption or therapeutic effect at that site of systemic absorption. direct deposition of slow-release or active substances is possible. In the case of central nervous system (CNS) deposition, intranasal inhalation aerosol delivery deposits pirfenidone or pyridone analog compounds directly upstream of the CNS compartments.

Similar to the intranasal and pulmonary applications described above, treatment or prevention of extra-airway organs requires absorption into systemic vascular areas for transport to these extra-respiratory sites. be done. Deposition of the drug in the respiratory tract, more particularly in the deep lung, through the left atrium into either the carotid arteries or the coronary arteries in the treatment or prevention of fibrotic or inflammatory diseases involving the heart, liver and kidneys. and direct access to these organs. Similarly, when treating CNS disorders (e.g. multiple sclerosis), deposition of drugs in the airways or nasal cavities (as defined above), more specifically absorption from the nasal cavities into the capillary beds of the nose. allows immediate access to the brain and CNS. This direct delivery allows direct administration of high concentrations of pirfenidone or pyridone analog compounds without unnecessary systemic exposure. Likewise, this route allows titration of dosage to levels that may be important for these indications.

<Pharmaceutical composition>
For purposes of the methods described herein, the pyridone analog compound, most preferably pirfenidone, may be administered using liquid nebulization, dry powder or metered dose inhalers. In some embodiments, the pirfenidone or pyridone analog compounds disclosed herein are used for aerosol formation, dosage for indication, location of deposition, pulmonary, intranasal/sinus, or extra-respiratory therapeutic. It is produced as a pharmaceutical composition suitable for pulmonary or intranasal delivery for action, excellent taste, manufacturing and storage stability, and patient safety and tolerability.

In some embodiments, the pyridone analog compounds, most preferably pirfenidone isoform content, are manufactured to improve drug substance and drug product stability, nasal and/or pulmonary dissolution (dry powder or suspension). formulation), tolerance, and site of action (lung, nasal/sinus, or local tissue).

<Manufacturing>
In some embodiments, the pirfenidone drug product (DP) is an aqueous buffer ₍ citrate or phosphate) with optional added salts ₍ NaCl and/or MgCl2 and/or MgSO4). pH=4-8) at a concentration of about 1 mg/mL to about 100 mg/mL of pirfenidone. In some embodiments, the pirfenidone formulation also contains co-solvents (by non-limiting examples ethanol, propylene glycol, and glycerin) and/or surfactants (by non-limiting examples Tween 80, Tween 60, lecithin, cetylpyridinium , and Tween 20). In some embodiments, the formulation also includes a flavoring agent (by non-limiting example, sodium saccharin).

A manufacturing process is described to achieve pirfenidone concentrations above 3 mg/mL. In one embodiment, the manufacturing process includes dissolution of hot pirfenidone in water, addition of co-solvents and/or surfactants and/or salts, and subsequent cooling to ambient temperature. In this process, additional co-solvents and/or surfactants and/or salts stabilize the hot melted pirfenidone during the cooling process and provide a stable, concentrated, ambient temperature formulation of pirfenidone. I will provide a. In some embodiments, the treatment temperature is 30°C, 35°C, 40°C, 45°C, 50°C, 55°C, 60°C, 65°C, 70°C, 75°C, 80°C, 85°C, 90°C, 95° C., 100° C., or other pressurizable elevated temperature. In some embodiments, the process includes addition of surfactants and/or co-solvents and/or salts at the highest temperature or at progressively lower temperatures as the solution cools. In some embodiments, addition of surfactant and/or co-solvent and/or salt occurs abruptly or gradually while the temperature is maintained or as the solution cools. The time the solution is maintained at the maximum temperature is from 0 minutes to 24 hours. The time the solution is cooled from the maximum temperature is from 0 minutes to 24 hours. In some embodiments, the solution is protected from light. In some embodiments, the solution is watered to remove or reduce the oxygen concentration. In some embodiments, the headspace of the reaction vessel comprises an inert gas or mixture of inert gases. Inert gases include, but are not limited to, nitrogen and argon. In some embodiments, pirfenidone formulations include co-solvents at concentrations ranging from 0% to 100% in other buffered aqueous solutions. In some embodiments, the pirfenidone formulation includes a co-solvent at a concentration of about 1% to about 25%. Co-solvents include, but are not limited to, ethanol, glycerin, or propylene glycol. In some embodiments, pirfenidone formulations include surfactants at concentrations ranging from 0% to 100% in other buffered aqueous solutions. In some embodiments, pirfenidone formulations include a surfactant at a concentration of about 0.1% to about 10%. Surfactants include, but are not limited to, Tween 20, Tween 60, Tween 80, cetylpyridinium bromide, or lecithin. In some embodiments, the pirfenidone formulation includes a buffer. In some embodiments, the buffer comprises salt and/or acid forms of the drug, such as citrate, phosphate, or formate, at concentrations between 0 mM and 1000 mM. In some embodiments, the buffer comprises salt and/or acid forms of the drug, such as citrate, phosphate, or formate, at concentrations between 1 mM and 50 mM. In some embodiments, pirfenidone formulations include salts. In some embodiments, salt is present at a concentration between 0% and 100%. In some embodiments, salt is present at a concentration between about 0.1% and about 5%. In some embodiments, the salt is sodium chloride, magnesium chloride, magnesium sulfate, or barium chloride. In some embodiments, a sweetener is added to the pirfenidone formulation. In some embodiments, the sweetener is saccharin or a salt thereof. In some embodiments, the sweetener is present at a concentration between about 0.01 mM and about 10 mM. In some embodiments, the pH of the buffer solution will be between about 2.0 and about 10.0.

In another embodiment, the manufacturing process comprises adding excess co-solvent and/or surfactant and/or cations to the supersaturated aqueous solution of pirfenidone. Dissolution of excess co-solvents and/or surfactants and/or cations in an aqueous solution dilutes the formulation and reduces the concentrations of co-solvents and/or surfactants and/or cations to safe and/or non-toxic and/or or reduced to within a generally recognized concentration range such that it is not irritant sensitive.

In some embodiments, the manufacturing process is as described in Example 5.

<Administration>
A pyridone analog compound (most preferred pirfenidone disclosed herein) at a therapeutically effective dose (e.g., a dose sufficient to provide treatment for the previously described disease states) can be administered. Generally, a daily aerosol dose of pirfenidone, eg, in a pirfenidone compound formulation, can be from about 0.001 mg to about 6.6 mg pirfenidone/kg of body weight per dose. Thus, for administration to a 70 kg human, dosage ranges are from about 0.07 mg to about 463 mg pirfenidone per dose, or from about 0.280 mg to about 1852 mg pirfenidone per day. The amount of active compound administered will, of course, depend on the subject and disease state to be treated, the severity of the disease, the method and schedule of administration, the location of the disease (e.g. nasal or upper respiratory tract, pharyngeal or laryngeal delivery). , bronchial delivery, pulmonary delivery, and/or pulmonary delivery with subsequent systemic or central nervous system absorption), and the judgment of the prescribing physician; The approximate dose range for aerosol administration of pirfenidone in the form, or in other embodiments of the pyridone analog compound, is about 0.28 to 1852 mg per day.

Another unexpected observation is that inhalation delivery of aerosol pirfenidone to the lungs shows less metabolism of pirfenidone than observed with oral administration. Thus, oral or intranasal inhalation of pirfenidone or pyridone analogues allows maximum levels of active ingredient to lung tissue without substantial metabolism to inactive drug.

Inhibitors of CYP enzymes reduce pirfenidone metabolism resulting in high blood levels and associated toxicity. Many products that generate CYP enzymes are useful for fibrotic patients, and therefore, approval of their use is beneficial. While the oral route is already at the maximum acceptable dose (it provides only moderate efficacy), any inhibition of the enzymes mentioned above raises pirfenidone blood levels, as described herein. Increase the rate and severity of toxic events. Because oral and intranasal inhalation delivery of pirfenidone or pyridone analogs can achieve effective tissue levels with much less drug than is required by oral products, the resulting blood levels are Results associated with significantly lower and inhibitory properties of the CYP enzymes described herein are excluded. Therefore, permitting the use of these CYP inhibitor enzyme products is currently contraindicated in oral medicines.

The major metabolite of pirfenidone is 5-carboxy-pirfenidone. After oral or intravenous administration, this metabolite appears rapidly at high concentrations in the blood. 5-Carboxy-pirfenidone does not appear to have anti-fibrotic or anti-inflammatory effects, and its elevated blood levels result from loss of pirfenidone blood levels. Thus, while oral products are taken at the highest possible levels, once pirfenidone enters the blood, it is rapidly metabolized to inactive species, further reducing drug potential and reducing appreciable efficacy. Achieve the required adequate lung levels. Extrapulmonary metabolism is not a factor, as oral and nasal inhalation delivery of pirfenidone or pyridone analogs can be achieved directly to effective lung tissue levels.

Administration of pirfenidone disclosed herein, such as a pyridone analogue compound, most preferably a pharmaceutically acceptable salt thereof, can be administered, for example, as a mist or spray containing particles of liquid as delivered by a nebulizer. It can be via any of the accepted modes of administration for the drug that serve similar utilities, including but not limited to aerosol inhalation such as nasal and/or oral inhalation.

Thus, pharmaceutically acceptable compositions can include solid, semi-solid, liquid and aerosol dosage forms such as, for example, powders, liquids, suspensions, complexes, liposomes, microparticles, and the like. Preferably, the compositions are presented in unit dosage forms suitable for single administration of precise dosages. Unit dosage forms may also be assembled and packaged together to provide a weekly or monthly supply to the patient and may contain saline, flavoring agents, pharmaceutical excipients, and other active ingredients or carriers. Other compounds may be incorporated, such as

Pirfenidone disclosed herein, such as a pyridone analog compound, most preferably a pharmaceutically acceptable salt thereof, may be used alone or, more typically, with conventional pharmaceutical carriers, excipients, etc. (e.g., mannitol, lactose, starch, magnesium stearate, sodium saccharin, talcan, cellulose, croscarmellose sodium, glucose, gelatin, sucrose, magnesium carbonate, magnesium chloride, magnesium sulfate, calcium chloride, lactose, sucrose, glucose, etc.) and Any combination may be administered. If desired, the pharmaceutical compositions may also contain minor amounts of nontoxic auxiliary substances such as wetting agents, emulsifying agents, solubilizing agents, pH buffering agents and the like (e.g. citric acid, ascorbic acid, sodium phosphate, potassium phosphate , sodium acetate, sodium citrate, cyclodextrin derivatives, sorbitan laurate monoester, triethanolamine acetate, triethanolamine oleate, etc.). Generally, depending on the intended mode of administration, pharmaceutical formulations contain from about 0.005% to 95%, preferably from about 0.1% to 50%, by weight of the compound of the invention. The actual methods of preparing such dosage forms are known, or apparent to those skilled in the art; see, e.g., Remington's Pharmaceutical Sciences, Mack Publishing Company, Easton, Pennsylvania.

In one preferred embodiment, the composition is in the form of a unit dosage form, such as a vial containing a liquid, a suspended solid, a dry powder, a lyophilisate, or other composition; The product contains, together with the active ingredient, diluents such as lactose, sucrose, dicalcium phosphate, and the like; lubricants, such as magnesium stearate or the like; and starch, gum acacia, polyvinylpyrrolidine, gelatin, cellulose, Binders such as cellulose derivatives or the like may be included.

For example, liquid pharmaceutically manageable compositions contain an active compound as defined above and optional adjuvants in a carrier (e.g., water, saline, aqueous dextrose, glycerol, glycol, ethanol, or and the like) by dissolving and dispersing to form a solution or suspension. Aerosolized solutions can be either as liquid solutions or suspensions, or as emulsions, or in solid form suitable for dissolution or suspension in liquid prior to aerosol formation and inhalation. can be prepared in conventional forms. The proportion of active compound contained in such aerosol compositions will depend largely on the specific properties of the compound as well as the activity of the compound and the needs of the subject. However, percentages of active ingredient from 0.01% to 90% in solution are available and will be higher if the composition is a solid, which will later dilute the above percentages. In some embodiments, the composition contains 0.25% to 50.0% active agent in solution.

Compound formulations of pirfenidone or pyridone analogues can be divided into two groups; simple formulations and complex formulation groups are pH-optimized, immediate-release formulations for improved tolerance, stability and tolerance. Or provide the taste masking agent with sustained release and/or area under curve (AUC) shape enhancing properties. Monolithic formulations can be further divided into three groups. 1. Single unit formulations may include water-based liquid formulations for nebulization therapy. By way of non-limiting example, a water-based liquid formulation may consist of the pirfenidone or pyridone analogue compound alone or with non-encapsulated water-soluble excipients. 2. Monolithic formulations may also include liquid organism-based formulations for nebulization or metered dose inhalers. By way of non-limiting example, an organic-based liquid formulation may be constituted with a pirfenidone or pyridone analogue compound or an unencapsulated organic soluble excipient. 3. Unitary formulations may also include dry powder formulations for administration by a dry powder inhaler. By way of non-limiting example, the dry powder formulation consists of the pirfenidone or pyridone analog compound alone, or with or without additives such as lactose, either water-soluble or organic-soluble, encapsulated. It can be configured with any of the following excipients: Complex formulations can be further divided into five groups. 1. Complex formulations may include water-based liquid formulations for aerosol therapy. By way of non-limiting example, water-based liquid complex formulations include pirfenidone encapsulated or complexed with water-soluble excipients such as lipids, liposomes, cyclodextrins, microencapsulations and emulsions. or may consist of compounds that are analogs of pyridone. 2. Complex formulations may also include organic-based liquid formulations for nebulization or metered dose inhalers. By way of non-limiting example, complex formulations include pirfenidone or pyridone encapsulated or complexed with organic soluble excipients such as lipids, microencapsulations, and inverse water-based emulsions. It may consist of analog compounds. 3. Complex formulations may also include low-solubility water-based liquid formulations for aerosol therapy. By way of non-limiting example, low-solubility water-based liquid complex formulations can be prepared as low-solubility, stable nanosuspensions alone or as co-crystals/coprecipitates, such as lipid nanosuspensions. The compounds may be composed of pirfenidone or pyridone analogues in complexes with excipients or in mixtures with low-soluble lipids. 4, Complex formulations may also include low organic soluble based liquid formulations for nebulization or metered dose inhalers. By way of non-limiting example, low-solubility organic-based liquid complex formulations, such as lipid nanosuspensions, as low-solubility, stable nanosuspensions alone or as co-crystals/coprecipitates It may be composed of pirfenidone or pyridone analog compounds in complexes with physical excipients or in mixtures with low-soluble lipids. 5. Composite formulations can also include dry powder formulations for administration using a dry powder inhaler. By way of non-limiting example, the complex dry powder formulation may be a co-crystal/co-precipitate/spray-dried complex, or low water solubility in dry powder form with or without additives such as lactose. It may be composed of pirfenidone or pyridone analog compounds in a form/mixture with salt. Specific methods for the preparation of single and complex formulations are described herein.

<Aerosol delivery>
A pirfenidone or pyridone analog compound as described herein is administered as an aerosol, preferably directly to the site of a pulmonary lesion, including pulmonary fibrosis, COPD or asthma. Aerosols may also be absorbed into the pulmonary vasculature for the treatment or prevention of extrapulmonary lesions, such as fibrosis and inflammatory diseases of the heart, kidney, and liver, or extrapulmonary effects associated with the central nervous system. Or it can be delivered to the pulmonary compartment for pulmonary delivery or nasal delivery for demyelinating diseases of the nasal cavity.

Several device technologies exist for delivering dry powder or liquid aerosolized products. Dry powder formulations generally require less time for dosing but require a longer and more expensive development effort. Conversely, liquid formulations have historically suffered from longer dosing times, but have the advantage of shorter and less expensive development efforts. The pirfenidone or pyridone analog compounds disclosed herein are variably soluble, generally stable, and have a variety of tastes. In one such embodiment, the pirfenidone or pyridone analog compound is limited to being soluble at pH 4 to pH 8, stable in aqueous solutions, and tasteless. Such pyridones include pirfenidone.

Thus, in one embodiment, certain formulations of the pirfenidone or pyridone analog compounds disclosed herein are combined with an aerosolization device to treat sites of infection, pulmonary arterial hypertension, extranasal and/or extrapulmonary It provides an aerosol for inhalation that is optimized for maximum drug deposition with pulmonary or intranasal sites for systemic absorption in indications and maximum tolerance. Factors that can be optimized include solution or solid microparticle formulation, rate of delivery, and particle size and particle distribution produced by the aerosolization device.

<Particle size and particle distribution>
The aerosol particle size/droplet size distribution can be expressed in terms of any of the following:
- median aerodynamic diameter (MMAD) - droplet size in which half of the mass of the aerosol is contained in smaller droplets and half of the larger droplets;
- volume mean diameter (VMD);
- mass median diameter (MMD);
- Fine Particle Fraction (FPF) - the percentage of particles that are less than 5 μm in diameter.

These measurements were used to compare the in vitro performance of different inhalation devices and drug combinations. In general, the higher the fine particle fraction, the higher the proportion of the emitted dose that is likely to deposit in the lungs.

Generally, inhaled particles are subject to deposition by one of two mechanisms: impaction (usually significant for larger particles) and sedimentation (common for smaller particles). . Impaction occurs when the molecules of inhaled particles are large enough that they do not follow air currents and strike physiological surfaces. In contrast, sedimentation occurs primarily in the deep lung when very small particles entrained in the inhaled airflow impinge on physiological surfaces as a result of random diffusion within the airflow.

For pulmonary administration, the upper airways are avoided in favor of the middle and lower airways. Pulmonary drug delivery can be accomplished by inhalation of an aerosol through the mouth and throat. Particles with a median aerodynamic diameter (MMAD) greater than about 5 microns generally do not reach the lungs; instead they tend to affect the back of the throat and are swallowed, possibly orally. be absorbed. Particles having a diameter of about 1 to about 5 microns are small enough to reach the upper to middle lung regions (the conducting airways), but are too large to reach the alveoli. Smaller particles (ie, about 0.5 to about 2 microns) can reach the alveolar region. Very small particles can be released, but particles with diameters less than about 0.5 microns can also be deposited in the alveolar region by sedimentation. A measure of particle size may be referred to as the volume mean diameter (VMD), mass median diameter (MMD), or MMAD. These measurements can be made by impaction (MMD and MMAD) or by laser (VMD). For liquid particles, the VMD, MMD and MMAD may be the same if the environmental conditions are maintained (eg, normal humidity). However, if humidity is not maintained, MMD and MMAD measurements will be less than VMD due to dehydration during impactor measurements. For the purposes of this description, the VMD, MMD and MMAD measurements are considered under standard conditions so that the VMD, MMD and MMAD descriptions are comparable. Similarly, dry powder particle size tests on MMD and MMAD are also considered comparable.

In some embodiments, the aerosol particle size maximizes deposition of the pirfenidone or pyridone analog compound at sites of pulmonary pathology and/or extrapulmonary, systemic, or central nervous system distribution, (or, in later cases, systemic absorption). Aerosol particle size can be expressed in terms of median aerodynamic diameter (MMAD). Large particles (eg, MMAD>5 μm) can be deposited in the upper respiratory tract because they are too large to pass through the curvature of the upper respiratory tract. Small particles (eg, MMAD <2 μm) may be poorly deposited in the lower respiratory tract and thus become expelled, providing additional opportunities for upper respiratory tract deposition. Thus, intolerance (eg, coughing and bronchospasm) can result from upper respiratory tract deposition from both inhalation impaction of large particles and sedimentation of small particles during repeated inhalation and ejection. Therefore, in one embodiment, an optimal particle size is used to maximize deposition in the mid-lungs and minimize intolerance associated with upper respiratory tract deposition (e.g., MMAD = 2-5 μm ). Furthermore, the production of defined particle sizes with limited geometric standard deviation (GSD) optimizes deposition and resistance. A narrow GSD limits the number of particles outside the desired MMAD size range. In one embodiment, an aerosol comprising one or more compounds disclosed herein is provided having an MMAD of about 2 microns to about 5 microns with a GSD of about 2.5 microns or less. . In another embodiment, an aerosol is provided having an MMAD of about 2.8 microns to about 4.3 microns with a GSD of 2 microns or less. In another embodiment, an aerosol is provided having an MMAD of about 2.5 microns to about 4.5 microns with a GSD of 1.8 microns or less.

In some embodiments, pirfenidone or pyridone analog compounds intended for respiratory delivery (for systemic or local distribution) are administered as aqueous formulations, suspensions or solutions in halogenated hydrocarbon propellants. or as a dry powder. Aqueous formulations can be aerosolized by liquid nebulizers that utilize either hydraulic or ultrasonic atomization. Propellant-based systems may use a suitable pressurized metered dose inhaler (pMDI). Dry powders may use a dry powder inhaler device (DPI), which can effectively disperse the drug substance. Desired particle size and distribution can be obtained by selecting an appropriate device.

Pulmonary deposition as used herein refers to an active pharmaceutical ingredient (API) that is bioavailable at a particular site of pharmacological activity upon administration of the drug to a patient via a particular delivery route. refers to a fraction of the nominal dose of For example, 30% lung deposition means that 30% of the active ingredient in the inhalation device is deposited in the lungs just prior to administration. Similarly, 60% pulmonary deposition means that 60% of the active ingredient in the inhalation device immediately prior to administration is deposited in the lungs and the like. Lung deposition can be measured using scintigraphic or deconvolution methods. In some embodiments, the present invention provides methods and inhalation systems for the treatment or prevention of a respiratory condition in a patient, wherein a liquid nebulizer administers a nominal dose of a pirfenidone or pyridone analog compound to the patient. including the step of In some embodiments, the liquid nebulizer is a high efficiency liquid nebulizer. In some embodiments, at least about 7%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, or at least about 85% pulmonary deposition of the pirfenidone or pyridone analog compound is achieved.

There are two main methods used to measure aerosol deposition in the lung. First, gamma-scintigraphy is performed by radiolabeling the drug with a substance such as 99m-technetium and scanning the subject after inhaling the drug. This technique has the advantage of being able to quantify the proportion of the aerosol inhaled by the patient as well as the local distribution in the upper respiratory tract and lungs. Second, pharmacokinetic techniques are used to measure pulmonary deposition, since most drugs deposited in the lower respiratory tract are absorbed into the bloodstream. Although this technique is able to assess the total amount of ICS that interacts with the airway epithelium and is systemically absorbed, it overlooks the small fraction that can be exhaled and swallowed after mucociliary clearance, resulting in localized distribution. would not be able to tell us about Therefore, gamma-scintigraphy and pharmacokinetic studies are often considered complementary.

In some embodiments, administration of the pirfenidone or pyridone analog compound by a liquid nebulizer is from about 1.0 μm to about 2.5 μm, from about 1.2 μm to about 2.0 μm, or from about 1.0 μm to about 2.0 μm. A GSD of the released particle size distribution of 0 μm is provided. In some embodiments, the MMAD is about 0.5 μm to about 5 μm, or about 1 to about 4 μm, or less than 5 μm. In some embodiments, the VMD is from about 0.5 μm to about 5 μm, or from about 1 to about 4 μm, or less than about 5 μm.

Fine Particle Fraction (FPF) describes the efficiency of nebulizer inhalation devices. FPF represents the fraction of aerosol dose delivered, or inhaled mass, with droplets less than 5.0 μm in diameter. Droplets less than 5.0 μm in diameter are believed to penetrate the lungs. In some embodiments, administration of a pirfenidone or pyridone analog solution with a liquid nebulizer is at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about Provide an RDD of 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, or at least about 80%.

The delivered dose (DD) of drug to the patient is the specified fraction of the volume of liquid filled in the nebulizer (fill volume) that is expelled from the mouthpiece of the device. The difference between the nominal dose and the DD is primarily the total amount of non-residual volume (i.e., the total fill volume remaining in the nebulizer after administration) or in the aerosol form during exhalation from the patient. Lost and therefore not deposited in the patient's body. In some embodiments, the DD of the nebulized formulations described herein is at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, or at least about 80%.

The respirable delivery dose (RDD) is the delivered mass expression of the drug contained within droplets emitted from the nebulizer that are small enough to reach and deposit on the germinal epithelium of the patient's lungs. is. RDD is measured by multiplying DD by FPF.

In one embodiment, aqueous droplets comprising a pirfenidone or pyridone analog compound are described herein, wherein the aqueous droplets have a diameter of less than about 5.0 μm. In some embodiments, the aqueous droplets are less than about 5.0 μm, less than about 4.5 μm, less than about 4.0 μm, less than about 3.5 μm, less than about 3.0 μm, less than about 2.5 μm, less than about It has a diameter of less than 2.0 μm, less than about 1.5 μm, or less than about 1.0 μm. In some embodiments, the aqueous droplets contain one or more cosolvents. In some embodiments, one or more co-solvents are selected from ethanol and propylene glycol. In some embodiments, the aqueous droplet further comprises a buffering agent. In some embodiments, the buffer is citrate buffer or phosphate buffer. In some embodiments, droplets were generated from a liquid nebulizer and an aqueous solution of a pirfenidone or pyridone analog compound as described herein. In some embodiments, the aqueous droplets contain a pirfenidone or pyridone analog compound concentration of between about 0.1 mg/mL and about 60 mg/mL, and from about 50 mOsmol/kg to about 6000 mOsmol/kg. was produced from an aqueous solution having an osmolality of In some embodiments, the osmolality is greater than about 100 mOsmol/kg. In some embodiments, the osmolality is greater than about 400 mOsmol/kg. In some embodiments, the osmolality is greater than about 1000 mOsmol/kg. In some embodiments, the osmolality is greater than about 2000 mOsmol/kg. In some embodiments, the osmolality is greater than about 3000 mOsmol/kg. In some embodiments, the osmolality is greater than about 4000 mOsmol/kg. In some embodiments, the osmolality is greater than about 5000 mOsmol/kg.

Also described is an aqueous aerosol comprising a plurality of aqueous droplets of a pirfenidone or pyridone analog compound as described herein. In some embodiments, at least about 30% of the aqueous droplets in the aerosol have diameters less than about 5 μm. In some embodiments, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65% of the aqueous droplets in the aerosol; At least about 70%, at least about 75%, at least about 80%, at least about 85%, or at least about 90% have a diameter of less than about 5 μm. In some embodiments, the aqueous aerosol is produced with a liquid nebulizer. In some embodiments, the aqueous aerosol is produced with a high efficiency liquid nebulizer.

<Liquid sprayer>
In one embodiment, the nebulizer is based primarily on enabling the formation of an aerosol of a pirfenidone or pyridone analog compound disclosed herein having an MMAD of between about 1 and about 5 microns. selected. In one embodiment, the delivered amount of the pirfenidone or pyridone analog compound provides a therapeutic effect on pulmonary pathology and/or extrapulmonary, systemic, tissue or central nervous system distribution.

It was previously shown that two types of nebulizers (jet and ultrasonic) can generate and deliver aerosol particles with sizes between 2 and 4 microns. These particle sizes have been shown to be optimal for mid-airway deposition. However, unless a specially formulated solution is used, these nebulizers typically require a larger mass to administer a sufficient amount of drug to obtain a therapeutic effect. A jet nebulizer utilizes pneumatic cutting of an aqueous solution into droplets of an aerosol. Ultrasonic nebulizers utilize the shearing of aqueous solutions by piezoelectric crystals. Typically, however, jet nebulizers are only about 10% efficient under clinical conditions, while ultrasonic nebulizers are only about 5% efficient. Thus, the amount of drug deposited and absorbed in the lungs is only 10%, despite the large amount of drug placed in the nebulizer. The amount of drug placed in the nebulizer prior to administration to a mammal is commonly referred to as the "nominal dose" or "loaded dose." The volume of solution containing the nominal dose is referred to as the "fill volume." Smaller particle sizes or slower inhalation rates allow deep lung deposition. Both mid-lung and alveolar deposition may be desired for this invention depending on the indication (eg, pulmonary fibrosis and mid- and/or alveolar deposition for systemic delivery). Exemplary disclosures of compositions and methods for formulation delivery using a nebulizer can be found, for example, in US 2006/0276483, which describes techniques for delivery of an aerosolized mist using a vibrating mesh nebulizer, Contains descriptions of protocols and properties.

Thus, in one embodiment, the vibrating mesh nebulizer delivers an aerosol of a pirfenidone compound as disclosed herein in a preferred embodiment, or an analogue of pyridone as disclosed herein in another embodiment. are used to deliver compounds of A vibrating mesh nebulizer includes a reservoir of liquid in fluid contact with diaphragm valves and inspiratory and expiratory valves. In one embodiment, about 1 to about 6 ml of a pirfenidone compound formulation (or, in another related embodiment, a pyridone analog compound formulation) is placed in a reservoir, and the aerosol generator is optionally Second, it involves producing a finely divided aerosol with a particle size of between about 1 and about 5 microns. In one embodiment, about 1 to about 10 ml of the pirfenidone compound formulation (or, in another related embodiment, the pyridone analog compound formulation) is placed in a reservoir and the aerosol generator is optionally Second, it involves producing a finely divided aerosol with a particle size of between about 1 and about 5 microns. In one embodiment, for the volume of pirfenidone compound formulation (or, in another related embodiment, the pyridone analogue compound formulation) originally placed in the reservoir, the aerosol generator will size the administered dose. replaced to increase

In some embodiments, a pirfenidone or pyridone analog compound formulation as disclosed herein is placed in a liquid nebulizer inhaler and produced in a particle size of between about 1 and about 5 microns. A dosage of about 0.5 to about 6 ml of the solution comprising the MMAD described herein is prepared to deliver from about 34 mcg to about 463 mg.

In some embodiments, a pirfenidone or pyridone analog compound formulation as disclosed herein is placed in a liquid nebulizer inhaler and produced in a particle size of between about 1 and about 5 microns. A dosage of about 0.5 to about 7 ml of the solution comprising the MMAD described herein is prepared to deliver from about 34 mcg to about 463 mg.

By way of non-limiting example, the nebulized pirfenidone or pyridone analog compound can be administered for less than about 20 minutes, less than about 15 minutes, less than about 10 minutes, less than about 7 minutes, less than about 5 minutes, less than about 3 minutes, or about It can be administered within the stated, respirable delivered dose in less than 2 minutes.

By way of non-limiting example, nebulized pirfenidone or pyridone analog compounds can be administered for less than about 20 minutes, less than about 15 minutes, less than about 10 minutes, less than about 7 minutes, less than about 5 minutes using a breath-controlled nebulizer. It can be administered within the described respirable delivered dose in less than, less than about 3 minutes, or less than about 2 minutes.

By way of non-limiting example, in other situations nebulized pirfenidone or pyridone analog compounds may reach improved tolerance and/or when administered for longer periods of time, the area under the curve ( AUC) shape-enhancing properties. Under these conditions, about 2 minutes or more, preferably about 3 minutes or more, more preferably about 5 minutes or more, more preferably about 7 minutes or more, more preferably about 10 minutes or more, and some Most preferably, the described respirable dose delivered in about 10 to about 20 minutes.

As disclosed herein, a pirfenidone compound having a pH of from about 4.0 to pH 8.0 when the compound is present at a concentration of pirfenidone from about 34 mcg/mL to about 463 mg/mL of pirfenidone. A compound formulation composition of a pyridone analog is provided that includes an aqueous solution. In certain other embodiments, the pirfenidone compound formulation comprises an aqueous solution having a pH of from about 4.0 to about 8.0, a solution comprising pirfenidone compound at a concentration of pirfenidone from about 34 mcg/mL to about 463 mg/mL; And it is provided as a citrate buffer or phosphate buffer with a concentration of about 0 mM to about 50 mM. In certain other embodiments, the pirfenidone compound formulation comprises an aqueous solution having a pH of from about 4.0 to about 8.0, a solution comprising pirfenidone compound at a concentration of pirfenidone from about 34 mcg/mL to about 463 mg/mL; and has a pKa of between 4.7 and 6.8 and maintains a pH of about 4.0 to about 8.0 for a period of time sufficient to allow storage over the shelf life of a salable commodity. A buffer that is present at a sufficient concentration to maintain or maintain after titration with an acid or group.

In some embodiments, pharmaceutical compositions are described herein that include pirfenidone; water; a phosphate or citrate buffer; and, optionally, sodium chloride or magnesium chloride. water; a buffer; and at least one additional compound selected from sodium chloride, magnesium chloride, ethanol, propylene glycol, glycerol, polysorbate 80 and cetylpyridinium bromide (or chloride). Pharmaceutical compositions comprising ingredients are described herein. In some embodiments, the buffer is phosphate buffer. In other embodiments, the buffer is citrate buffer. In some embodiments, the pharmaceutical composition comprises 1 mg to 500 mg of pirfenidone, such as 5 mg, 10 mg, 15 mg, 25 mg, 37.5 mg, 75 mg, 100 mg, 115 mg, 150 mg, 190 mg, 220 mg, or 500 mg. In some embodiments, the osmolality of the pharmaceutical compositions described herein is between about 50 mOsmo/kg and 6000 mOsmo/kg. In some embodiments, the osmolality of the pharmaceutical compositions described herein is between about 50 mOsmo/kg and 5000 mOsmo/kg. In some embodiments, the pharmaceutical composition optionally includes saccharin (eg, sodium salt). In some embodiments, such pharmaceutical compositions are prepared from a volume of about 0.5 to about 6 ml of solution with a particle size of the MMAD being produced with a particle size of between about 1 and about 5 microns. , in liquid nebulizers for delivery of up to about 1 mg and about 500 mg. In some embodiments, such pharmaceutical compositions comprise about 1 mg from a dose of about 0.5 to about 7 ml of solution comprising MMADs produced with a particle size of between about 1 and about 5 microns. is placed in a liquid nebulizer to deliver up to about 500 mg. In some embodiments, such nebulized pharmaceutical compositions are between about 0.0001 mg and about 25 mg in aerosol particles with an MMAD of between 1 and 5 microns in each inhaled breath. of pirfenidone or pyridone analogs. In some embodiments, 1 mg of pirfenidone or pyridone analog delivered in 10 breaths over 1 minute, whereby 50% of the particles inhaled are between 1 and 5 microns, and 0.05 mg of pirfenidone or The pyridone analog will be delivered in each breath. In some embodiments, 1 mg of pirfenidone or pyridone analog delivered in 15 breaths over 10 minutes, whereby 50% of the particles inhaled are between 1 and 5 microns, and 0.0033 mg of pirfenidone or The pyridone analog will be delivered in each breath. In some embodiments, 1 mg of pirfenidone or pyridone analog delivered in 20 breaths over 20 minutes, whereby 50% of the particles inhaled are between 1 and 5 microns, and 0.00125 mg of pirfenidone or The pyridone analog will be delivered in each breath. In some embodiments, 200 mg of pirfenidone or pyridone analog delivered in 10 breaths over 1 minute, whereby 50% of the particles inhaled are between 1 and 5 microns, and 10 mg of pirfenidone or pyridone The analog will be delivered in each breath. In some embodiments, 200 mg of pirfenidone or pyridone analog delivered in 15 breaths over 10 minutes, whereby 50% of the particles inhaled are between 1 and 5 microns, and 0.67 mg of pirfenidone or The pyridone analog will be delivered in each breath. By way of another non-limiting example, in some embodiments, 200 mg of pirfenidone or a pyridone analog delivered at 20 breaths per minute over 20 minutes, whereby 50% of the inhaled particles are 1 and 5 Between microns, 0.25 mg of the pirfenidone or pyridone analog would be delivered in each breath. In some embodiments, 500 mg of pirfenidone or pyridone analog delivered in 10 breaths over 1 minute, whereby 50% of the particles inhaled are between 1 and 5 microns, and 25 mg of pirfenidone or pyridone The analog will be delivered in each breath. In some embodiments, 500 mg of pirfenidone or pyridone analog delivered at 15 breaths per minute over 10 minutes whereby 50% of the inhaled particles are between 1 and 5 microns; 67 mg of pirfenidone or pyridone analog will be delivered in each breath. In some embodiments, 500 mg of pirfenidone or pyridone analog delivered at 20 breaths per minute over 20 minutes, whereby 50% of the inhaled particles are between 1 and 5 microns, and 0.5 micron. 625 mg of pirfenidone or pyridone analog will be delivered in each breath.

In some embodiments, the nebulized pirfenidone or pyridone analog compound is administered in less than about 20 minutes, less than about 10 minutes, less than about 7 minutes, less than about 5 minutes, less than about 3 minutes, or less than about 2 minutes. , at the respirable delivered doses described.

For aqueous and other non-pressurized liquid systems, a variety of nebulizers (including small volume nebulizers) are available for aerosolizing formulations. Compressor-driven nebulizers incorporate jetting technology and use compressed air to generate a liquid aerosol. Such devices are available from, for example, Healthdyne Technologies, Inc. Invacare, Inc.; Mountain Medical Equipment, Inc.; Pari Respiratory, Inc.; Mada Medical, Inc.; Puritan-Bennett; Schuco, Inc.; , DeVilbiss Health Care, Inc.; and Hospitak, Inc.; are commercially available from Ultrasonic nebulizers rely on mechanical energy in the form of vibrations of piezoelectric crystals to generate droplets of respirable liquid and are manufactured, for example, by Omron Healthcare Inc. , Boehringer Ingelheim, and DeVilbiss Health Care, Inc.; are commercially available from Vibrating mesh nebulizers rely on either piezoelectric material or mechanical pulses to generate droplets of respirable liquid. Other examples of nebulizers for use with the pirfenidone or pyridone analogs described herein are U.S. Pat. Nos. 4,268,460; 4,253,468; 4,046,146; 4,649,911; 4,510,929; 4,624,251; 5,164,740; 5,586,550; 6,644,304; 6,338,443; 5,906,202; 5,934,272; 5,960,792; 6,070,575; 6,192,876; 6,230,706; 6,349,719; 6,367,470; 6,584,971; 6,601,581; 4,263,907; 5,709,202; 5,823,179; 6,644,304; 5,549,102; 6,083,922; 6,161,536; 6,264,922; 6,612,303, all of which are incorporated herein by reference in their entireties.

Any known inhalation nebulizer suitable for providing drug delivery as described herein can be used in the various embodiments and methods described herein. Such nebulizers include, for example, jet nebulizers, ultrasonic nebulizers, pulsating membrane nebulizers, nebulizers with vibrating meshes or plates with many holes, and vibration generators and aqueous chambers (e.g. including a nebulizer containing Pari eFlow®). Commercially available nebulizers suitable for use in the present invention include Aeroneb®, MicroAir®, Aeroneb® Pro, and Aeroneb® Go, Aeroneb® Solo, Aeroneb® Solo/Idehaler combination, Aeroneb® Solo or Go Idehaler-Pocket® combination, PARI LC-Plus®, PARI LC-Star®, PARI Sprint®, eFlow and eFlow Rapid®, Pari Boy® N and Pari Duraneb® (PARI, GMBH), MicroAir® (Omron Healthcare, Inc.), Halolite ( (Profile Therapeutics Inc.), Respimat® (Boehringer Ingelheim), Aerodose® (Aerogen, Inc, Mountain View, Calif.), Omron Elite® (Omron Healthcare, Inc.), Omron Microair® (Omron Healthcare, Inc.), Mabismist II® (Mabis Healthcare, Inc.), Lumiscope® 6610, (Lumiscope Company, Inc.), Airsep Mystique® ( AirSep Corporation), Acorn-1 and Acorn-2 (Vital Signs, Inc.), Aquatower® (Medical Industries America), Ava-Neb® (Hudson Respiratory Care Incorporated), Cirrus® ( Intersurgical Incorporated), Dart® (Professional Medical Products), Devilbiss® Pulmo Aide (DeVilbiss Corp.). ), Downdraft® (Marquest), Fan Jet® (Marquest), MB-5 (Mefar), Misty Neb® (Baxter), Salter 8900 (Salter labs), Sidestream® (Medic-Aid), Updraft-II® (Hudson Respiratory Care), Whisper Jet® (Marquest Medical Products), Aiolos® (Aiolos Medic Optimist® (Unmedical Inc.), Prodomo®, Spira® (Respiratory Care Center), AERx® and AERx Essence™ (Aradigm), Respirgard II （登録商標）、Ｓｏｎｉｋ（登録商標）ＬＤＩ Ｎｅｂｕｌｉｚｅｒ（Ｅｖｉｔ Ｌａｂｓ）、Ｓｗｉｒｌｅｒ Ｗ Ｒａｄｉｏａｅｒｏｓｏｌ Ｓｙｓｔｅｍ（ＡＭＩＣＩ， Ｉｎｃ．社）、Ｍａｑｕｅｔ ＳＵＮ １４５ ｕｌｔｒａｓｏｎｉｃ、Ｓｃｈｉｌｌ ｕｎｔｒａｓｏｎｉｃ、ｃｏｍｐａｒｅ ａｎｄ ｃｏｍｐａｒｅ Ｅｌｉｔｅ ｆｒｏｍ Ｏｍｒｏｎ、Ｍｏｎｏｇｈａｎ ＡｅｒｏＥｃｌｉｐｓｅ ＢＡＮ、Ｔｒａｎｓｎｅｂ、 DeVilbiss 800, AerovectRx, Porta-Neb®, Freeway Freedom™, Sidestream, Philips, Inc. may include Ventstream and I-neb produced by . By way of further non-limiting example, US Pat. No. 6,196,219 is hereby incorporated by reference in its entirety.

Any of these and other known nebulizers suitable for providing delivery of aqueous inhalants as described herein may be used in various embodiments and methods described herein. can be used. In some embodiments, the nebulizer is from, for example, Pari GmbH (Starnberg, Germany), DeVilbiss Healthcare (Heston, Middlesex, UK), Healthdyne, Vital Signs, Baxter, Allied Health Care, Invacare, Hudson, Omron, AirSmed, , Luminscope, Medisana, Siemens, Aerogen, Mountain Medical, Aerosol Medical Ltd. (Colchester, Essex, UK); AFP Medical (Rugby, Warwickshire, UK); Bard Ltd.; (Sunderland, UK), Carri-Med Ltd. (Dorking, UK), Plaem Nuiva (Brescia, Italy), Henleys Medical Supplies (London, UK), Intersurgical (Berkshire, UK), Lifecare Hospital Supplies (Leies, UK), Medic-Aid Ltd. (West Sussex, UK), Medix Ltd.; (Essex, UK), Sinclair Medical Ltd. (Surrey, UK), and many others.

Other nebulizers suitable for use in the methods and systems described herein may include, but are not limited to, jet nebulizers (optionally sold with a compressor), ultrasonic nebulizers, and others. Typical jet nebulizers for use herein are: Pari LC plus/ProNeb, Pari LC plus/ProNeb Turbo, Pari LC Plus/Dura Neb 1000 & 2000, Pari LC plus/Walkhaler, Pari LC plus/Pari Master 、Ｐａｒｉ ＬＣ ｓｔａｒ、Ｏｍｒｏｎ ＣｏｍｐＡｉｒ ＸＬ Ｐｏｒｔａｂｌｅ ｎｅｂｕｌｉｚｅｒ Ｓｙｓｔｅｍ（ＮＥ－Ｃ１８及びＪｅｔＡｉｒ Ｄｉｓｐｏｓａｂｌｅ ｎｅｂｕｌｉｚｅｒ）、Ｏｍｒｏｎ ｃｏｍｐａｒｅ Ｅｌｉｔｅ Ｃｏｍｐｒｅｓｓｏｒ Ｎｅｂｕｌｉｚｅｒ Ｓｙｓｔｅｍ（ＮＥ－Ｃ２１及びＥｌｉｔｅ Ａｉｒ Ｒｅｕｓａｂｌｅ Ｎｅｂｕｌｉｚｅｒ）、Ｐｒｏｎｅｂ Ｕｌｔｒａ ｃｏｍｐｒｅｓｓｏｒを備えたＰａｒｉ ＬＣ Ｐｌｕｓ又はＰａｒｉ ＬＣ Ｓｔａｒ ｎｅｂｕｌｉｚｅｒ、Ｐｕｌｏｍｏ－ａｉｄｅ、Ｐｕｌｍｏ－ａｉｄｅ ＬＴ、Ｐｕｌｍｏ－ａｉｄｅ ｔｒａｖｅｌｅｒ、Ｉｎｖａｃａｒｅ Ｐａｓｓｐｏｒｔ、Ｉｎｓｐｉｒａｔｉｏｎ Ｈｅａｌｔｈｄｙｎｅ ６２６、Ｐｕｌｍｏ－Ｎｅｂ Ｔｒａｖｅｌｅｒ、ＤｅＶｉｌｂｉｓｓ ６４６、Ｗｈｉｓｐｅｒ ｊｅｔ、ＡｃｏｒｎＩＩ、Ｍｉｓｔｙ－Ｎｅｂ、Ａｌｌｉｅｄ ａｅｒｏｓｏｌ、Ｓｃｈｕｃｏ Ｈｏｍｅ Ｃａｒｅ、Ｌｅｘａｎ Ｐｌａｓｉｃ Pocet Neb, SideStream Hand Held Neb, Mobil mist, Up-Draft, Up-Draft II, T Up-Draft, ISO-NEB, Ava-Neb, Micro Mist, and PuImoMate.

Typical ultrasonic nebulizers suitable for providing drug delivery as described herein include MicroAir, UltraAir, Siemens Ultra Nebulizer 145, CompAir, Pulmosonic, Scout, 5003 Ultrasonic Neb, 5110 Ultrasonic Neb, 5004 Desk Ultrasonic Nebulizer, Mystique Ultrasonic, Lumiscope's Ultrasonic Nebulizer, Medisana Ultrasonic Nebulizer, Microstat Ultrasonic Nebulizer, and Mabismist Handheld Ultrasonic Nebulizer.本明細書で使用するための他の噴霧器は、５０００ Ｅｌｅｃｔｒｏｍａｇｎｅｔｉｃ Ｎｅｂ、５００１ Ｅｌｅｃｔｒｏｍａｇｎｅｔｉｃ Ｎｅｂ、５００２ Ｒｏｔａｒｙ Ｐｉｓｔｏｎ Ｎｅｂ、Ｌｕｍｉｎｅｂ Ｉ Ｐｉｓｔｏｎ Ｎｅｂｕｌｉｚｅｒ ５５００、Ａｅｒｏｎｅｂ Ｐｏｒｔａｂｌｅ ｎｅｂｕｌｉｚｅｒ Ｓｙｓｔｅｍ、Ａｅｒｏｄｏｓｅ Ｉｎｈａｌｅｒ、及びＡｅｒｏＥｃｌｉｐｓｅ Ｂｒｅａｔｈ Ａｃｔｕａｔｅｄ Ｎｅｂｕｌｉｚｅｒを含む。 A typical nebulizer comprising a vibrating mesh or a plate with a large number of holes is described by R.K. New Nebulizer Technology-Aerosol Generation by Using a vibrating Mesh or Plate with multiple apertures, Long-Term Healthcare Strategies 2003, (July), p. 1-4, and Respiratory Care, 47: 1406-1416 (2002), the entire disclosures of each of which are incorporated herein by reference.

Additional nebulizers suitable for use in the invention described herein include nebulizers that include a vibration generator and an aqueous chamber. Such atomizers are sold commercially, for example, as the Pari eFlow, and are disclosed in U.S. Pat. 456, each of which is specifically incorporated herein by reference.

The parameters used in nebulization, such as flow rate, mesh membrane size, aerosol inhalation chamber size, mask size and material, valves, and power source, differ from those in different types and aqueous inhalation mixtures. can be varied as applicable to provide drug delivery as described herein in order to maximize the use of.

In some embodiments, the drug solution is formed prior to use of the nebulizer by the patient. In other embodiments, the drug is stored in the nebulizer in liquid form, which may include suspensions, solutions, or the like. In other embodiments, the drug is stored in the nebulizer in solid form. In this case, the solution is as described in U.S. Pat. No. 6,427,682 and PCT International Publication No. WO 03/035030, both of which are incorporated herein by reference in their entirety. , are mixed during the operation of the nebulizer. In these nebulizers, the solid drug (optionally mixed with excipients to form a solid composition) is stored in a compartment separate from the liquid medium.

A liquid solvent can dissolve the solid composition to form a liquid composition, which can be aerosolized and inhaled. Such capabilities lie in other factors, the action of the selected amount, and potentially the liquid composition. To allow easy handling and reproducible dosing, sterile aqueous liquids are capable of dissolving solid compositions in short periods of time under as little agitation as possible. In some embodiments, the final liquid is ready for use after only about 30 seconds. In some cases, the solid composition dissolves within about 20 seconds, advantageously within about 10 seconds. As used herein, the terms "dissolved", "dissolving" and "dissolution" refer to the decomposition of a solid composition and release of the active compound, ie, dissolution. Dissolution of the solid composition by the liquid solvent results in the formation of a liquid composition containing the active compound in solution. As used herein, at least about 90 wt. -% is dissolved, and more preferably at least about 95 wt. - The active compound is in the dissolved state when % is dissolved.

With respect to the basic separated compartment nebulizer design, whether or not it is useful for containing aqueous liquid and solid compositions within separate chambers of the same container or main packaging. Whether should be provided in separate chambers depends primarily on the specific application. If separate containers are used, these are provided as a set within the same secondary packaging. The use of separate containers is particularly preferred for nebulizers containing more than one dose of active compound. There is no limit to the total number of containers provided within a multi-dose kit. In one embodiment, the solid composition is provided as unit doses in multiple containers or multiple chambers of containers, while the liquid solvent is provided in one chamber or container. In this case a preferred design provides the liquid in a metered dose dispenser, which may consist of a glass or plastic bottle closed by a dispensing device such as a mechanical pump for metering the liquid. For example, one actuation of the pump mechanism can dispense a precise amount of liquid to dissolve one dosage unit of the solid composition.

In another embodiment for multiple-dose separated-compartment nebulizers, both the solid composition and the liquid solvent are fitted in multiple containers or multiple chambers of containers. provided as a single unit dose. For example, a two-chamber container can be used to hold one unit of a solid composition in one chamber and one unit of liquid in the other chamber. As used herein, one unit is defined by the amount of drug in the solid composition, which is one unit dose. However, such two-compartment containers may also be used advantageously for nebulizers containing only one single drug dose.

In one embodiment of the separated compartment nebulizer, a blister pack having two blisters is used, the blisters containing the solid composition and the Represents a chamber for containing a liquid solvent. As used herein, a blister pack refers to a thermoformed or pressure-formed primary packaging unit, usually comprising a polymeric packaging material, optionally including a metallic foil such as aluminum. . Blister packs may be shaped to allow easy distribution of the contents. For example, one side of the pack may be tapered or have a tapered portion or region where the contents can be dispersed into another vessel upon opening the blister pack at the tapered end. A tapered end may present at the tip.

In some embodiments, the two chambers of the blister pack are connected by a channel, which is suitable for directing fluid from blisters containing liquid solvent to blisters containing solid composition. During storage, the channels are closed with seals. In this sense, a seal is any structure that prevents liquid solvent from contacting a solid composition. The seal is preferably frangible or removable; breaking or removing the seal allows liquid solvent to enter the other chamber and dissolve the solid composition when the nebulizer is used. becomes. The dissolution process can be improved by shaking the blister pack. A final liquid composition for inhalation is thus obtained, the liquid being present in one or both chambers of the packs connected by channels, depending on how the packs are held.

According to another embodiment, one of the chambers, preferably the one closer to the tapered portion of the blister pack, communicates with a second channel, which channel tapers from the chamber at the proximal position of the tapered portion. stretch to During storage, this second channel does not communicate with the outside of the pack, but is closed in an airtight manner. Optionally, the proximal end of the second channel is closed by a frangible or removable cap or plug, such as a threaded cap, a break-off cap, or a break-off cap. It may be a cut-off cap).

In one embodiment, a vial or container having two compartments is used, the compartments for containing the solid composition and the liquid solvent in amounts suitable to prepare dosage units of the final liquid composition. represents the chamber. The liquid composition and the second liquid solvent may be included in amounts compatible to prepare a dosage unit of the final liquid composition (by non-limiting examples, two soluble excipients or pirfenidone or pyridone and the excipients are storage unstable, but are desired in the same mixture for administration).

In some embodiments, the two compartments are physically separated but fluidly connected such that the vial or container is connected by a channel or frangible barrier, and the channel or frangible barrier is It is applied to orient the fluid between the two compartments to allow mixing prior to administration. During storage, the channels are closed with a seal or frangible barrier intact. In this sense, a seal is any structure that prevents mixing of the contents of the two compartments. The seal is preferably frangible or removable; breaking or removing the seal, when the nebulizer is used, allows the liquid solvent to enter the other chamber and dissolve the solid composition. , or in the case of two liquids, they can be mixed. The dissolution or mixing process can be improved by shaking the container. A final liquid composition for inhalation is thus obtained, the liquid being in one or both of the chambers of the pack connected by channels or frangible barriers, which depends on how the pack is retained. depends on

The solid composition itself can be provided in a variety of different types of dosage forms, depending on the physicochemical properties of the drug, desired dissolution rate, cost considerations, and other criteria. In one of the embodiments, the solid composition is a single unit. This implies that a single unit dose of drug is contained in a single, physically formed solid form or article of commerce. In other words, the solid composition is coherent, which is in contrast to multiple unit dosage forms in which the units are non-interfering.

Examples of single units that can be used as dosage forms for solid compositions include tablets such as compressed tablets, film units, foil units, wafers, freeze-dried matrix units, and the like. In preferred embodiments, the solid composition is in a highly porous, freeze-dried form. Such freeze-dried products (sometimes also called wafers or freeze-dried tablets) are particularly useful for their rapid dissolution, which also permits rapid dissolution of the active compounds.

Alternatively, for some applications, solid compositions may also be formed as multiple unit dosage forms, as defined above. Examples of composite units are powders, granules, microparticles, pellets, beads, freeze-dried powders, and the like. In one embodiment, the solid composition is a freeze-dried powder. Such a dispersed freeze-dried system contains many powder particles, and due to the freeze-drying process used in forming the powder, each particle is so dense that the powder absorbs water very quickly. It has an irregular and porous microstructure that allows for rapid degradation.

Another type of multiparticulate system that is also capable of achieving rapid drug dissolution is that of drug-coated powders, granules, or pellets from water-soluble excipients, As a result, the drug is located on the outer surface of the individual particles. In this type of system, water-soluble low molecular weight excipients are useful to prepare the core of such coated particles, which are then followed by the drug and, preferably, the binder, the pore The coating composition may be coated with one or more additional excipients such as molds, saccharides, sugar alcohols, film-forming polymers, plasticizers, or other excipients used in pharmaceutical coating compositions.

In another embodiment, the solid composition resembles a coating layer overlying a composite unit made of an insoluble material. Examples of insoluble units include beads made of glass, polymers, metals, and mineral salts. Again, the desired effect is primarily rapid degradation of the coating and rapid drug dissolution, which is achieved by providing the solid composition in a physical form with a particularly high surface-to-volume ratio. be. Typically, the coating composition comprises a drug and a water-soluble low molecular weight excipient plus one or more excipients such as those described above to coat the soluble particles, or a pharmaceutical coating composition. Include any other excipients known to be useful.

It may be useful to incorporate more than one water-soluble low molecular weight excipient into the solid composition to achieve the desired effect. For example, one excipient may be selected for its drug carrier and diluent dosage, while another excipient may be selected to adjust pH. If the final liquid composition needs to be buffered, two excipients can be selected that together form a buffer system.

In one embodiment, the liquid used in the separate compartment nebulizer is an aqueous liquid, which is defined herein as a liquid whose main component is water. The liquid does not necessarily consist exclusively of water; however, in one embodiment it is purified water. In another embodiment, the liquid contains other ingredients or substances (preferably other liquid ingredients), but also possibly dissolved solids. Liquid ingredients other than water that may be useful include propylene glycol, glycerol, and polyethylene glycol. One reason for incorporating solid compounds as solutes is that such compounds are desirable in the final liquid composition, but are incompatible with solid compositions or their components, such as active ingredients. .

Another desirable characteristic for a liquid solvent is that it be sterile. Aqueous liquids would be at considerable risk of microbiological contamination and growth if no measures were taken to ensure sterility. An effective amount of an acceptable antimicrobial agent or preservative may be incorporated to provide a substantially sterile liquid, or the liquid may be sterilized prior to providing it and sealing it with an airtight seal. In one embodiment, the liquid is a sterile liquid without preservatives and provided in a suitable airtight container. However, according to another embodiment in which the nebulizer contains multiple doses of the active compound, the liquid may be supplied in a multi-dose container, such as a metered dose dispenser, and after first use the microbiological may require preservatives to prevent contamination.

<High efficiency liquid sprayer>
A high efficiency liquid nebulizer is an inhalation device adapted to deliver a large portion of a filled dose to a patient. Some high efficiency liquid atomizers utilize microporous membranes. In some embodiments, high efficiency liquid atomizers also utilize one or more actively or passively vibrating microporous membranes. In some embodiments, high efficiency liquid atomizers include one or more vibrating membranes. In some embodiments, a highly efficient liquid nebulizer includes a vibration generator with a vibrating mesh or plate with multiple holes and optionally an aerosol mixing chamber. In some such embodiments, the mixing chamber functions to collect (or stage) the aerosol from the aerosol generator. In some embodiments, an inhalation valve is also used to allow the entry of atmospheric air into the mixing chamber during the inhalation phase and prevent escape of aerosol from the mixing chamber during the exhalation phase. closed for In some such embodiments, an exhalation valve is removably attached to the mixing chamber and positioned at a mouthpiece through which the patient inhales the aerosol from the mixing chamber. Also in some other embodiments, the high efficiency liquid atomizer includes a pulsating membrane. In some embodiments, the high efficiency liquid atomizer operates continuously.

In some embodiments, a high efficiency liquid atomizer comprising an oscillating microporous membrane in a tapered nozzle for large volumes of liquid will produce a column of droplets without the need for compressed gas. deaf. In these embodiments, the solution in the nebulizer of the microporous membrane contacts the membrane on the side opposite to that open to the air. The membrane is perforated by the mass nozzle orifices of the spray head. Aerosols are generated when alternating acoustic pressure builds up in the solution around the membrane causing the fluid on the liquid side of the membrane to be expelled through the nozzle as uniformly sized droplets.

In some embodiments, high efficiency liquid atomizers use passive nozzle membranes and discrete piezoelectric transducers in contact with the solution. In contrast, some high-efficiency liquid atomizers use an active nozzle membrane, which via high-frequency vibration of the nozzle membrane to generate very fine droplets of solution. , using acoustic pressure in the nebulizer.

Some high efficiency liquid atomizers include resonance systems. In some such high-efficiency liquid atomizers, the membrane is operated by a frequency with a particularly high amplitude of vibratory motion at the center of the membrane, resulting in a concentrated acoustic pressure around the nozzle; The resonant frequency can be approximately 100 kHz. Resilient supports are used to keep unwanted loss of vibrational energy to the mechanical environment of the spray head to a minimum. In some embodiments, the vibrating membrane of a high efficiency liquid atomizer can be made of a nickel-palladium alloy by electroforming.

In some embodiments, the high efficiency liquid nebulizer is (i) at least about 5%, at least about 6%, at least about 6%, at least about 7%, at least about 8%, at least about 9%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least achieving lung deposition of about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, or at least about 85% do.

In some embodiments, the high efficiency liquid atomizer has (ii) about 1.0 μm to about 2.5 μm, about 1.2 μm to about 2.5 μm, about 1.3 μm to about 2.0 μm, at least about 1 .4 μm to about 1.9 μm, at least about 1.5 μm to about 1.9 μm, at least about 1.5 μm, about 1.7 μm, or about 1.9 μm of solution administered with a high efficiency liquid nebulizer; Provides the geometric standard deviation (GSD) of the dropped droplet size distribution.

In some embodiments, the high efficiency liquid atomizer is (iii) about 1 μm to about 5 μm, about 2 to about 4 μm, about 2.5 to about 4.0 μm of solution emitted by the high efficiency liquid atomizer. It provides the median aerodynamic diameter (MMAD) of the particle size of . In some embodiments, the high efficiency liquid atomizer provides (iii) a volume mean diameter (VMD) of 1 μm to about 5 μm, about 2 to about 4 μm, or about 2.5 to about 4.0 μm. In some embodiments, the high efficiency liquid atomizer provides (iii) a mass median diameter (MMD) of 1 μm to about 5 μm, about 2 to about 4 μm, or about 2.5 to about 4.0 μm.

In some embodiments, the high efficiency liquid atomizer is (iv) at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, or at least about Provides 90% fine fraction (FPF=%≦5 microns) of droplets emitted from a high efficiency atomizer.

In some embodiments, the high efficiency liquid nebulizer has (v) at least 0.1 mL/min, at least 0.2 mL/min, at least 0.3 mL/min, at least 0.4 mL/min, at least Provides an output rate of 0.5 mL/min, at least 0.6 mL/min, at least 0.8 mL/min, or at least 1.0 mL/min.

In some embodiments, the high efficiency liquid sprayer comprises (vi) at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about Deliver about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, or at least about 80%.

In some embodiments, the high efficiency liquid atomizer is at least about 5%, at least about 6%, at least about 7%, at least about 8%, at least about 9%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least Provide an RDD of about 70%, at least about 75%, at least about 80%, or at least about 85%.

In some embodiments, high efficiency liquid atomizers are characterized as providing one or more of (i), (ii), (iii), (iv), (v), or (vi). In some embodiments, the highly efficient liquid atomizer comprises at least one, at least two, at least three of (i), (ii), (iii), (iv), (v), or (vi) , at least four, at least five, or all six.

Additional features of highly efficient liquid atomizers with perforated membranes are disclosed in U.S. Patent Nos. 6,962,151; 5,152,456; 179, and US Pat. No. 6,983,747, each of which is incorporated herein by reference in its entirety. Another embodiment of a highly efficient liquid atomizer includes a vibratable membrane. These high efficiency liquid atomizer features are disclosed in 7,252,085; 7,059,320; 6,983,747, each of which is incorporated herein by reference in its entirety.

Commercial high-efficiency liquid nebulizers are available from: PARI (Germany) under the trade name eFlow®; Nektar Therapeutics (San Carlos, Calif.) under the trade name AeroNeb® Go; and AeroNeb® Pro, and AeroNeb® Solo, trade names I-Neb® from Respironics (Murrysville, Calif.), Micro-Air® from Omron (Bannckburn, Ill.), Activaero ( Germany). Commercial high efficiency nebulizers are also available from Aerogen (Galaway, Ireland), which utilizes OnQ® nebulizer technology.

<Medium dose inhaler (MDI)>
A propellant driven inhaler (pMDI) releases a metered dose of drug upon each actuation. The drug is formulated as a suspension or solution of the drug substance in a suitable propellant such as a halogenated hydrocarbon. pMDIs are described, for example, in Newman, S.; P. , Aerosols and the Lung, Clarke et al. , eds. , pp. 197-224 (Butterworths, London, England, 1984).

In some embodiments, the particle size of the drug substance in the MDI can be optimally selected. In some embodiments, the particles of active ingredient have a diameter of less than about 50 microns. In some embodiments, particles have a diameter of less than about 10 microns. In some embodiments, particles have diameters from about 1 micron to about 5 microns. In some embodiments, particles have a diameter of less than about 1 micron. In one advantageous embodiment, the particles have a diameter of from about 2 microns to about 5 microns.

By way of non-limiting example, a metered dose inhaler (MDI), a pirfenidone or pyridone analog compound disclosed herein may be dosed to deliver from about 34 mcg to about 463 mg from a formulation that meets the requirements of an MDI. prepared in Pirfenidone or pyridone analog compounds disclosed herein are soluble in propellants, soluble in propellants with the addition of co-solvents (ethanol by way of a non-limiting example), and additional moieties that promote increased solubility. It may be soluble in propellants (glycerol or phospholipids by non-limiting examples), stable suspensions, or micronized, spray-dried or nanosuspensions.

By way of non-limiting example, a dose of pirfenidone or a pyridone analogue compound may be administered in 10 or less inhaled breaths, more preferably 8 or less inhaled breaths, more preferably 6 or less inhaled breaths, more preferably 8 or less. The described respirable delivery doses can be administered in inhalation breaths, more preferably in 4 inhalation breaths or less, more preferably in 2 inhalation breaths or less.

Propellants for use with MDIs can be any propellant known in the art. Examples of propellants include chlorofluorocarbons (CFCs) such as dichlorodifluoromethane, trichlorofluoromethane, and dichlorotetrafluoroethane; hydrofluoroalkanes (HFA); and carbon dioxide. Due to environmental concerns associated with the use of CFCs, it may be advantageous to use HFAs instead of CFCs. Examples of pharmaceutical aerosol preparations containing HFA are presented in U.S. Pat. Nos. 6,585,958; are incorporated herein. In some embodiments, a co-solvent is mixed with the propellant to facilitate dissolution or suspension of the drug substance.

In some embodiments, the propellant and active ingredient are contained in separate containers, as described in U.S. Pat. No. 4,534,345, which is incorporated herein by reference in its entirety. incorporated.

In some embodiments, MDIs used herein are actuated by the patient pressing a lever, button, or other actuator. In other embodiments, the aerosol emission is breath activated, US Pat. Nos. 6,672,304; 5,404,871; 5,284,133; 5,217,004; 5,119,806; 5,060,643; 4,664,107; 4,648,393; 3,732,864; 3,636,949; 3,598,294; 3,565,070; 3,456,646; , 645; and 3,456,644, so that, after initial delivery of the unit, once the patient begins to inhale, an aerosol of the active compound is released, which is described in each of the references. each of which is incorporated herein by reference in its entirety. Such systems allow more active compound to enter the patient's lungs. Another mechanism for helping patients obtain proper dosages with active ingredients is to inhale drugs, as described in US Pat. Nos. 4,470,412 and 5,385,140. , both of which are incorporated herein by reference in their entirety.

Additional examples of MDIs known in the art and suitable for use herein are U.S. Patent Nos. 6,435,177; 6,585,958; 5,642,730; 4,955,371; 5,404,871; 5,364,838; and 6,523,536, all of which are incorporated herein by reference in their entirety. incorporated herein by reference.

<Dry powder inhaler (DPI)>
There are two main designs for dry powder inhalers. The first design is a metered device in which a reservoir for the drug is placed within the device and the patient adds a dose of drug into the inhalation chamber. The second is a manufactured metered device in which individual doses are manufactured in separate containers. Both systems rely on the formulation of drug into small particles with a mass median diameter of about 1 to about 5 microns, and larger excipient particles (typically 100 micron diameter lactose particles). A co-formulation with The drug powder is placed in the inhalation chamber (either by device metering or by cutting a manufactured metered dose) and the patient's inspiratory flow accelerates the powder out of the device and into the oral cavity. The non-laminar flow characteristics of the powder path cause the excipient drug aggregates to break up, with large amounts of large excipient particles causing their impaction in the back of the throat, while the smaller drug particles is deeply deposited in the lungs.

As with liquid sprays and MDIs, the particle size of aerosol formulations of pirfenidone or pyridone analog compounds can be optimized. If the particle size is greater than the MMAD of about 5 microns, then the particles are deposited in the upper respiratory tract. If the aerosol particle size is less than about 1 micron, then it can be delivered to the alveoli and moved into the systemic blood circulation.

By way of non-limiting example, in a dry powder inhaler, the pirfenidone or pyridone analog compounds disclosed herein are prepared in dosages to disperse and deliver from about 34 mcg to about 463 mg from a dry powder formulation. be done.

By way of non-limiting example, a dry powder pirfenidone or pyridone analog compound can be used for 10 or less inhaled breaths, more preferably 8 or less inhaled breaths, more preferably 6 or less inhaled breaths, more preferably 8 or less breaths. The described respirable delivery doses can be administered in inhalation breaths, more preferably in 4 inhalation breaths or less, more preferably in 2 inhalation breaths or less.

In some embodiments, a dry powder inhaler (DPI) is used to dispense a pirfenidone or pyridone analog compound described herein. DPIs contain the drug substance in the form of fine, dry particles. Typically, inhalation by a patient causes dry particles to form an aerosol cloud that is inhaled into the patient's lungs. Fine dry drug particles can be produced by any technique known in the art. Some well-known techniques include the use of jet mills or other comminution equipment, precipitation from solutions of saturated or supersaturated solutions, spray drying, in situ micronization (Hovione), or supercritical fluid processes. A typical powder formulation involves the production of spherical pellets or an adhesive mixture. In the adhesive mixture, the drug particles are attached to larger carrier particles, such as lactose monohydrate, sized from about 50 to about 100 microns in diameter. Larger carrier particles increase the aerodynamic forces on the carrier/drug aggregates to improve aerosol formation. Turbulent and/or mechanical devices separate the agglomerates into their components. The smaller drug particles are then inhaled into the lungs, while the larger carrier particles are deposited in the oral cavity or throat. Some examples of adhesive mixtures are described in US Pat. All are incorporated by reference in their entirety. Additional excipients may also be included with the drug substance.

There are three common types of DPIs, all of which can be used with the pirfenidone or pyridone analog compounds described herein. In a single dose DPI, a capsule containing a single dose of dry drug substance/excipient is filled into the inhaler. Upon actuation, the capsule is ruptured and the dry powder is dispersed allowing it to be inhaled using a dry powder inhaler. To distribute the additional dose, the old capsule must be removed and an additional capsule filled. Examples of single dose DPIs are described in U.S. Patent Nos. 3,807,400; 3,906,950; 3,991,761; incorporated herein by reference. In a multiple unit dose DPI, packaging is provided that includes multiple single dose compartments. For example, the packaging may comprise a blister pack, where each blister compartment contains a single dose. Each dose may be dispersed by breaking the blister compartment. Any of several arrangements of compartments within the package may be used. For example, annular or strip arrangements are common. Examples of multiple unit dose DPIs are described in EPO Patent Application Publication Nos. 0211595A2, 0455463A1, and 0467172A1, all of which are incorporated herein by reference in their entirety. In a multi-dose DPI, a single reservoir of dry powder is used. U.S. Patent Nos. 5,829,434; 5,437,270; 2,587,215; 5,113,855; 5,840,279; 4,667,668; 5,033,463; and 4,805,811, and PCT International Publication WO 92/09322. Mechanisms for measuring dosage amounts are provided, all of which are incorporated herein by reference.

In some embodiments, supplemental energy, either in addition to patient inhalation or otherwise, may be provided to facilitate operation of the DPI. 5,113,855; 5,388,572; 6,029,662; and PCT International Publication WO 93/12831, WO 90/07351, and WO 99/62495, all of which are incorporated herein by reference in their entireties. Electrically driven impellers are also disclosed in U.S. Patent Nos. 3,948,264; 3,971,377; 4,147,166; 6,006,747; , all of which are incorporated herein by reference. Another mechanism is a motorized tapping piston, as described in PCT International Publication No. WO 90/13327, which is hereby incorporated by reference in its entirety. Other DPIs use vibrators, as described in U.S. Pat. Nos. 5,694,920 and 6,026,809, both of which are incorporated herein by reference in their entirety. be taken. Finally, a scraper system may be used as described in PCT International Publication No. WO 93/24165, which is incorporated by reference in its entirety.

Additional examples of DPIs for use herein are US Patent Nos. 4,811,731; 5,113,855; 5,840,279; 3,669,113; 3,635,219; 3,991,761; 4,353,365; 4,889,144, 4,907,538; 829,434; 6,681,768; 6,561,186; 5,918,594; 6,003,512; 794; and 6,626,173, all of which are incorporated herein by reference.

4,790,305; 4,926,852; 5,012,803; 5,040. 5,024,467; 5,816,240; 5,027,806; and 6,026,807. in conjunction with any of the inhalers described herein, all of which are incorporated herein by reference. For example, a spacer can delay the time from the time the aerosol is generated to the time the aerosol enters the patient's oral cavity. Such a delay may improve synchronization between patient inhalation and aerosol generation. Masks are also disclosed in U.S. Patent Nos. 4,809,692; 4,832,015; 5,012,804; 5,427,089; 988,160, for infants or other patients who have difficulty using conventional mouthpieces, all of which are incorporated herein by reference.

Dry powder inhalers (DPIs), which involve the breakup and aerosolization of dry powder particles, typically rely on bursts of inhaled air drawn through the unit to deliver the drug dose. Such devices are for example U.S. Pat. No. 4,807,814 (which is directed to a pneumatic powder discharge device with suction and injection stages); SU 628930 (Abstract) (air on shaft describe a hand-held powder dispenser with a flow-through tube); Fox et al. , Powder and Bulk Engineering, pages 33-36 (March 1988) (describing a venturi discharge device with an axial intake pipe upstream of the venturi restriction); EP 347 779 (collapsible expansion chamber and US Pat. No. 5,785,049, which is directed to a dry powder delivery device for drugs.

Commercial examples of dry powder inhalers that may be used with the pirfenidone or pyridone analog compound formulations described herein include the Aerolizer, Turohaler, Handihaler and Discus.

<Solution/dispersion formulation>
In one embodiment, an aqueous formulation comprising soluble or nanoparticulate drug particles is provided. For aqueous aerosol formulations, the drug may be present in concentrations from about 34 mcg/mL to about 463 mg/mL. In some embodiments, the drug is from about 1 mg/mL to about 463 mg/mL, or from about 1 mg/mL to about 400 mg/mL, or from about 0.1 mg/mL to about 360 mg/mL, or from about 1 mg/mL to about 300 mg/mL, or about 1 mg/mL to about 200 mg/mL, or about 1 mg/mL to about 100 mg/mL, or about 1 mg/mL to about 50 mg/mL, or about 5 mg/mL to about 50 mg/mL; or present in a concentration from about 10 mg/mL to about 50 mg/mL, or from about 15 mg/mL to about 50 mg/mL, or from about 20 mg/mL to about 50 mg/mL. Such formulations have the additional advantage of allowing large amounts of drug substance to be delivered to the lungs in a very short period of time for effective delivery to the appropriate regions of the lungs. An aerosol formulation is provided. In one embodiment, the formulation is optimized to provide a well-tolerated formulation. Thus, in one embodiment, the pirfenidone or pyridone analogue compounds disclosed herein have an excellent taste, a pH of about 4.0 to about 8.0, a dosage of about 100 to about 5000 mOsmol/kg. Formulated to have an osmolality. In some embodiments, the osmolarity is from about 100 to about 1000 mOsmol/kg. In some embodiments, the osmolarity is from about 200 to about 500 mOsmol/kg. In some embodiments, the osmotic ion concentration is from about 30 to about 300 mM.

In some embodiments, a pirfenidone or pyridone analogue compound, water, and selected from co-solvents, tonicity agents, sweeteners, surfactants, wetting agents, chelating agents, antioxidants, salts, and buffers. Aqueous pharmaceutical compositions are described herein that include one or more additional ingredients. It should be understood that many excipients can serve several functions even within the same formulation.

In some embodiments, the pharmaceutical compositions described herein do not contain any thickening agents.

In some embodiments, the concentration of the pirfenidone or pyridone analog compound in the aqueous pharmaceutical composition is between about 0.1 mg/mL and about 100 mg/mL. In some embodiments, the concentration of the pirfenidone or pyridone analog compound in the pharmaceutical composition is between about 1 mg/mL and about 100 mg/mL, between about 10 mg/mL and about 100 mg/mL, about 20 mg/mL. between about 25 mg/mL and about 100 mg/mL, between about 30 mg/mL and about 100 mg/mL, between about 15 mg/mL and about 50 mg/mL, between about 20 mg/mL Between about 50 mg/mL, between about 25 mg/mL and about 50 mg/mL, or between about 30 mg/mL and about 50 mg/mL.

In some embodiments, the pH is between about pH 4.0 and about pH 8.0. In some embodiments, the pH is between about pH 5.0 and about pH 8.0. In some embodiments, the pH is between about pH 6.0 and about pH 8.0. In some embodiments, the pH is between about pH 6.5 and about pH 8.0.

In some embodiments, aqueous pharmaceutical compositions include one or more co-solvents. In some embodiments, an aqueous pharmaceutical composition comprises one or more co-solvents when the total amount of co-solvents is from about 1% to about 50% v/v of the total volume of the composition. In some embodiments, the aqueous pharmaceutical composition comprises one or more co-solvents, wherein the total amount of co-solvents is from about 1% to about 50% v/v, from about 1% to about 40% of the total volume of the composition. % v/v, from about 1% to about 30% v/v, or from about 1% to about 25% v/v. Co-solvents include, but are not limited to, ethanol, propylene glycol and glycerol. In some embodiments, the aqueous pharmaceutical composition comprises ethanol from about 1% v/v to about 25%. In some embodiments, the aqueous pharmaceutical composition comprises ethanol at about 1% v/v to about 15%. In some embodiments, the aqueous pharmaceutical composition is about 1% v/v, 2% v/v, 3% v/v, 4% v/v, 5% v/v, 6% v/v , 7% v/v, 8% v/v, 9% v/v, 10% v/v, 11% v/v, 12% v/v, 13% v/v, 14% v/v, 15 % v/v, 16% v/v, 17% v/v, 18% v/v, 19% v/v, 20% v/v, 21% v/v, 22% v/v, 23% v/v /v, 24% v/v, or 25% v/v with ethanol. In some embodiments, the aqueous pharmaceutical composition comprises glycerol from about 1% v/v to about 25%. In some embodiments, the aqueous pharmaceutical composition comprises glycerol from about 1% v/v to about 15%. In some embodiments, the aqueous pharmaceutical composition is about 1% v/v, 2% v/v, 3% v/v, 4% v/v, 5% v/v, 6% v/v , 7% v/v, 8% v/v, 9% v/v, 10% v/v, 11% v/v, 12% v/v, 13% v/v, 14% v/v, 15 % v/v, 16% v/v, 17% v/v, 18% v/v, 19% v/v, 20% v/v, 21% v/v, 22% v/v, 23% v/v /v, 24% v/v, or 25% v/v with glycerol. In some embodiments, the aqueous pharmaceutical composition comprises propylene glycol from about 1% v/v to about 50%. In some embodiments, the aqueous pharmaceutical composition comprises propylene glycol from about 1% v/v to about 25%. In some embodiments, the aqueous pharmaceutical composition is about 1% v/v, 2% v/v, 3% v/v, 4% v/v, 5% v/v, 6% v/v , 7% v/v, 8% v/v, 9% v/v, 10% v/v, 11% v/v, 12% v/v, 13% v/v, 14% v/v, 15 % v/v, 16% v/v, 17% v/v, 18% v/v, 19% v/v, 20% v/v, 21% v/v, 22% v/v, 23% v/v propylene glycol at /v, 24% v/v, or 25% v/v.

In some embodiments, the aqueous pharmaceutical composition comprises ethanol at about 1% v/v to about 25% and propylene glycol at about 1% v/v to about 50%. In some embodiments, the aqueous pharmaceutical composition comprises ethanol at about 1% v/v to about 15% and propylene glycol at about 1% v/v to about 30%. In some embodiments, the aqueous pharmaceutical composition comprises ethanol at about 1% v/v to about 8% and propylene glycol at about 1% v/v to about 16%. In some embodiments, the aqueous pharmaceutical composition comprises ethanol twice as much as propylene glycol on a volume basis.

In some embodiments, an aqueous pharmaceutical composition includes a buffer. In some embodiments, the buffer is citrate buffer or phosphate buffer. In some embodiments, the buffer is citrate buffer. In some embodiments, the buffer is phosphate buffer.

In some embodiments, the aqueous pharmaceutical composition comprises a pirfenidone or pyridone analog compound, water, ethanol and/or propylene glycol, a buffer to maintain a pH between about 4 and 8, and optionally a salt, an interfacial It consists essentially of one or more ingredients selected from active agents and sweeteners (flavoring agents). In some embodiments, one or more salts are selected from tonicity agents. In some embodiments, one or more salts are selected from sodium chloride and magnesium chloride.

In some embodiments, the aqueous pharmaceutical composition comprises a pirfenidone or pyridone analog compound at a concentration of about 10 mg/mL to about 50 mg/mL, water, one or two co-solvents (about 1% v/v to ethanol at a concentration of about 25% v/v, and/or propylene glycol at a concentration of about 1% v/v to about 50% v/v), a buffer to maintain the pH at about 4-8, and optionally It consists essentially of one or more ingredients selected from salts, surfactants and sweeteners (flavoring agents).

In one embodiment, the solution or diluent used to prepare the aerosol formulation has a pH range of about 4.0 to about 8.0. This pH range improves tolerance. If the aerosol is either acidic or alkaline it can cause bronchospasm and coughing. The safe range of pH is relative; some patients can tolerate mildly acidic aerosols, while others experience bronchospasm. Any aerosol with a pH below about 4.0 typically causes bronchospasm. Aerosols with a pH greater than about 8.0 may have low tolerance because body tissues are generally unable to buffer alkaline aerosols. Aerosols with a controlled pH below about 4.0 and above about 8.0 typically result in pulmonary inflammation associated with severe bronchospastic coughing and inflammatory reactions. For these reasons as well as avoidance of bronchospasm, coughing or inflammation in the patient, the optimal pH for the aerosol formulation is determined between about pH 4.0 and about pH 8.0.

By way of non-limiting example, compositions may also include buffers or pH adjusting agents, typically salts prepared from organic acids or bases. Representative buffers include organic acid salts of citric acid, ascorbic acid, gluconic acid, carbonic acid, tartaric acid, succinic acid, acetic acid, or phthalic acid, Tris, tromethamine, hydrochloride or phosphate buffers.

Many patients have increased sensitivities to various chemical tastes, including bitter, salty, sweet, and metallic sensations. By way of non-limiting example, taste masking can be accomplished through the addition of taste-masking excipients, adjusted osmolality, and sweeteners to create a well-tolerated formulation.

Many patients have increased sensitivities to various chemicals and have a high incidence of bronchospastic, asthmatic or other coughs. Their airways are particularly sensitive to hypotonic or hypertonic and acidic or alkaline conditions and to the presence of any unaltered ions such as chloride. Any imbalance in these conditions or the presence of chloride above a certain value can lead to bronchospastic or inflammatory events and/or coughing which greatly impairs treatment with inhalable formulations. Both of these conditions prevent efficient delivery of aerosolized drugs into the endobronchial space.

In some embodiments, the osmolality of an aqueous solution of a pirfenidone or pyridone analog compound disclosed herein is adjusted by providing an excipient. In some cases, a specific amount of chloride or another anion is required for good and effective delivery of an aerosolized pirfenidone or pyridone analog compound.

In some embodiments, the osmolality of an aqueous solution of a pirfenidone or pyridone analog compound disclosed herein is greater than 100 mOsmol/kg. In some embodiments, the osmolality of an aqueous solution of a pirfenidone or pyridone analog compound disclosed herein is greater than 300 mOsmol/kg. In some embodiments, the osmolality of an aqueous solution of a pirfenidone or pyridone analog compound disclosed herein is greater than 1000 mOsmol/kg. In some embodiments, aerosol delivery of aqueous solutions with high osmolality (ie, greater than about 300 mOsmol/kg) has a high incidence of bronchospastic, asthmatic, or other cough. In some embodiments, aerosol delivery of an aqueous solution having a high osmolality (i.e., greater than about 300 mOsmol/kg) as described results in bronchospastic, asthmatic, or other coughing episodes. Do not increase rate.

In some embodiments, by providing an excipient, the osmolality of an aqueous solution of a pirfenidone or pyridone analog compound disclosed herein is greater than 100 mOsmol/kg. In some cases, a certain amount of chloride or another anion is required for good and effective delivery of an aerosolized pirfenidone or pyridone analog compound.

In some embodiments, the aerosol formulation for pirfenidone or pyridone analog compound is about 1 to about 5 ml of dilute saline (between 1/10 and 2/1 normal saline), It may contain from about 34 mcg to about 463 mg of pirfenidone or pyridone analog compound. Thus, the concentration of the pirfenidone or pyridone analogue compound solution is greater than about 34 mcg/ml, greater than about 463 mcg/ml, greater than about 1 mg/ml, greater than about 2 mg/mL, greater than about 3.0 mg/mL. It may be greater than about 3.7 mg/mL, greater than about 10 mg/mL, greater than about 37 mg/mL, greater than about 50 mg/mL, greater than about 100 mg/mL, or greater than 463 mg/mL.

In some embodiments, the osmolality of the solution is from about 100 mOsmol/kg to about 6000 mOsmol/kg. In some embodiments, the osmolality of the solution is from about 100 mOsmol/kg to about 5000 mOsmol/kg. In some other embodiments, the osmolality of the solution is from about 400 mOsmol/kg to about 5000 mOsmol/kg.

In one embodiment, the osmotic ion concentration is from about 25 mM to about 400 mM. In various other embodiments, the osmotic ion concentration is from about 30 mM to about 300 mM; from about 40 mM to about 200 mM; and from about 50 mM to about 150 mM.

<Solid fine particle formulation>
In some embodiments, solid drug nanoparticles are provided for use in generating dry aerosols or for generating nanoparticles in liquid suspension. Nanoparticulate drug-containing powders can be made by spray drying an aqueous dispersion of nanoparticulate drug and surface modifier to form a dry powder composed of aggregated drug nanoparticles. In one embodiment, aggregates may have a size of about 1 to about 2 microns, suitable for deep lung delivery. The aggregate particle size can be adjusted by increasing the concentration of drug in the spray-dried dispersion or by increasing the size of the droplets produced by spray-drying, such as the upper bronchial segments or nasal mucosa. It can be increased to target alternate delivery sites.

Alternatively, the aqueous dispersion of drug and surface modifier may contain a dissolved diluent, such as lactose or mannitol, which when spray-dried contains particles of respirable diluent. , each comprising at least one embedded drug nanoparticle and a surface modifier. Particles of diluent with embedded drug may have a particle size of about 1 to about 2 microns, suitable for deep lung delivery. Additionally, the particle size of the diluent can be adjusted by increasing the concentration of dissolved diluent in the aqueous dispersion prior to spray drying or by increasing the size of the droplets produced by the spray dryer. , may be increased to target alternative delivery sites such as upper bronchial segments or nasal mucosa.

Spray-dried powders can be used either alone or in combination with freeze-dried nanoparticulate powders in DPI or pMDI. In addition, the spray-dried powder containing drug nanoparticles produces an aqueous dispersion with respirable droplet sizes when each droplet contains at least one drug nanoparticle. Additionally, it can be reconfigured and used in either a jet or ultrasonic nebulizer. Concentrated nanoparticulate dispersions may also be used in these embodiments of the invention.

Nanoparticulate drug dispersions can also be freeze-dried to obtain powders suitable for nasal or pulmonary delivery. Such powders may comprise particles of agglomerated nanoparticulate drug having surface modifiers. Such aggregates may have a size within the respirable range (eg, MMAD of about 1 to about 5 microns).

A freeze-dried powder of suitable particle size is also obtained by freeze-drying an aqueous dispersion of drug and surface modifier, which further contains a dissolved diluent such as lactose or mannitol. In these examples, the freeze-dried powder consists of respirable particles of diluent, each of which contains at least one embedded drug nanoparticle.

Freeze-dried powders can be used either alone or in combination with spray-dried nanoparticulate powders in DPI or pMDI. In addition, the freeze-dried powder containing drug nanoparticles produces an aqueous dispersion with respirable droplet sizes when each droplet contains at least one drug nanoparticle. Additionally, it can be reconfigured and used in either a jet or ultrasonic nebulizer.

One embodiment of the present invention is directed to processes and compositions for propellant-based systems comprising nanoparticulate drug particles and surface modifiers. Such formulations may be prepared by wet milling coarse drug substances and surface modifiers in liquid propellants under conditions of either ambient pressure or elevated pressure. Alternatively, dry powders containing drug nanoparticles can be prepared by spray-drying or freeze-drying aqueous dispersions of drug nanoparticles, and the resulting powders are sprayed suitable for use in conventional pMDIs. dispersed in an agent. Such nanoparticulate pMDI formulations can be used for either nasal or pulmonary delivery. For pulmonary administration, such formulations can increase delivery to deep lung regions due to the small particle sizes available from these methods (eg, MMAD of about 1 to about 2 microns). . Concentrated aerosol formulations can also be used in pMDIs.

Another embodiment is directed to a dry powder comprising a nanoparticulate composition for pulmonary or nasal delivery. The powder may consist of respirable aggregates of nanoparticulate drug particles or respirable particles of a diluent comprising at least one embedded drug nanoparticle. Powders containing nanoparticulate drug particles can be prepared from aqueous dispersions of nanoparticles by removing the water by spray drying or freeze drying (freeze drying). Spray-drying is less time-consuming and less expensive than freeze-drying, and is therefore more cost-effective. However, for certain drugs, such as biologics, freeze-drying is more effective than spray-drying to make dry powder formulations.

Conventional micronized drug particles used in dry powder aerosol delivery, having a particle size of MMAD from about 1 to about 5 microns, are weighed down due to the inherent electrostatic cohesive forces in such powders. and are often difficult to disperse in small amounts. These difficulties can lead to loss of drug substance to the delivery device, as well as incomplete powder dispersion and suboptimal pulmonary delivery. Many drug compounds, especially proteins and peptides, are intended for deep pulmonary delivery and systemic absorption. Since the average particle size of conventionally prepared dry powders typically ranges from about 1 to about 5 microns MMAD, the actual debris of material reaching the alveolar region may be fairly small. Therefore, delivery of micronized dry powders to the lungs, particularly the alveolar region, is generally very inefficient due to the properties of the powders themselves.

Dry powder aerosols containing nanoparticulate drugs can be smaller than comparable micronized drug substances and are therefore suitable for efficient delivery to the deep lung. In addition, nanoparticulate drug aggregates are spherical in shape and have good flow properties, thereby aiding dose measurement and deposition of compositions administered in the lungs or nasal cavity.

Dry nanoparticulate compositions can be used in both DPIs and pMDIs. As used herein, "dry" refers to compositions having less than about 5% water.

In one embodiment, the composition has an effective average particle size of less than about 1000 nm, more preferably less than about 400 nm, less than about 300 nm, less than about 250 nm, or less than about 200 nm as measured by light scattering. provided to contain nanoparticles having By "effective average particle size less than about 1000 nm" is meant that at least 50% of the particles of drug have a weight average particle size less than about 1000 nm as measured by a light scattering technique. Preferably, at least 70% of the particles of drug have an average particle size of less than about 1000 nm, more preferably at least 90% of the particles of drug have an average particle size of less than about 1000 nm, and further More preferably, at least 95% of the particles have a weight average particle size of less than about 1000 nm.

For aqueous aerosol formulations, the nanoparticulate pirfenidone or pyridone analog compound drug can be present at a concentration of about 34 mcg/mL to about 463 mg/mL. For dry powder aerosol formulations, the nanoparticulate drug may be present at a concentration of about 34 mg/g to about 463 mg/g, depending on the desired drug dosage. Concentrated nanoparticulate aerosols (at concentrations of about 34 mcg/mL to about 463 mg/mL for aqueous aerosol formulations and about 34 mcg/mL to about 463 mg/mL for dry powder aerosol formulations) are specifically provided. Such formulations are effective in pulmonary administration with short administration times (i.e., less than about 3-15 seconds per dose, compared to administration times of 4-20 minutes or less, as seen with conventional pulmonary nebulizer therapy). or to provide effective delivery to appropriate areas of the nasal cavity.

Nanoparticulate drug compositions for aerosol administration can be prepared, for example, by (1) spraying a dispersion of nanoparticulate drug obtained either by milling or precipitation; aerosolizing a dry powder of the modifier population (the aerosolized composition may further include a diluent); or (3) nanoparticulate drug or drug population in a non-aqueous propellant. It can be made by aerosolizing a body suspension. Aggregates of nanoparticulate drug and surface modifiers (which may further include a diluent) may be made in non-pressurized or pressurized non-aqueous systems. Concentrated aerosol formulations can also be made by such methods.

Aqueous drug milling to obtain nanoparticulate drug is accomplished by dispersing the drug particles in a liquid dispersion medium and in the presence of a milling medium to reduce the drug particle size to the desired effective average particle size. can be carried out by applying mechanical means at Particles can be reduced in size in the presence of one or more surface modifiers. Alternatively, the particles can be contacted with one or more surface modifiers after attrition. Other compounds, such as diluents, may be added to the drug/surface modifier composition during the size reduction process. Dispersions can be manufactured continuously or in a batch mode.

Another method of forming nanoparticle dispersions is by microprecipitation. This is a drug with one or more surface modifiers and one or more colloidal stability enhancing surfactants free of any trace toxic solvents or solubilized heavy metal impurities. is a method of preparing a stable dispersion of For example, such methods include (1) dissolving the drug in a suitable solvent by mixing; (2) mixing into a solution containing at least one surface modifier to form a clear solution; adding the formulation of step (1); and (3) precipitating the formulation of step (2) by mixing using a suitable non-solvent. The method is followed by removal of any formed salts and, if present, diafiltration and concentration of the dispersion by conventional means. The resulting nanoparticulate drug dispersion can be utilized in a liquid nebulizer or processed to form a dry powder for use in a DPI or pMDI.

A non-aqueous liquid having a vapor pressure of 1 atm or less at room temperature in a non-aqueous, non-pressurized milling system and in which the drug substance is substantially insoluble makes the nanoparticulate drug composition. can be used as a wet milling medium for In such a process, a slurry of drug and surface modifier can be milled in a non-aqueous medium to produce nanoparticulate drug particles. Examples of suitable non-aqueous media include ethanol, trichloromonofluoromethane (CFC-11), and dichlorotetafluoroethane (CFC-114). The advantage of using CFC-11 is that CFC-11 can be handled only at slightly cooler room temperatures, while CFC-114 requires more controlled conditions to avoid evaporation. do. Upon completion of milling, the liquid medium may be removed and recovered under vacuum or by heating, resulting in a dry nanoparticulate composition. The dry composition can then be filled into a suitable container and charged with the final propellant. Typical end product propellants, ideally free of chlorinated hydrocarbons, include HFA-134a (tetrafluoroethane) and HFA-227 (heptafluoropropane). While non-chlorinated propellants may be preferred for environmental reasons, chlorinated propellants may also be used in this embodiment of the invention.

In a non-aqueous, pressurized milling system, a non-aqueous liquid medium having a vapor pressure significantly greater than 1 atm at room temperature can be used in the milling process to make the nanoparticulate drug composition. If the milling medium is a suitable halogenated hydrocarbon propellant, the resulting dispersion can be filled directly into suitable pMDI containers. Alternatively, the milling medium can be removed and recovered under vacuum or by heating, resulting in a dry nanoparticle composition. This composition can then be filled into a suitable container and a propellant suitable for use in a pMDI added.

Spray-drying is a process used to obtain a powder containing particles of nanoparticulate drug after micronization of the drug in a liquid medium. Generally, spray drying may be used when the liquid medium has a vapor pressure of less than about 1 atmosphere at room temperature. A spray dryer is a device that allows the evaporation of liquids and the collection of drug powders. A liquid sample, either as a solution or as a suspension, is supplied to the spray nozzle. The nozzle produces droplets of sample within the range of about 20 to about 100 microns in diameter which are then carried into the drying chamber by a carrier gas. Carrier gas temperatures are typically from about 80 to about 200°C. The droplets are subjected to rapid liquid evaporation, leaving dry particles that are collected in a special reservoir below the cyclonic device. Smaller particles ranging from about 1 micron to below about 5 microns are also possible.

When the liquid sample consists of an aqueous dispersion of nanoparticles and surface modifiers, the collected product consists of spherical aggregates of particles of nanoparticulate drug. If the liquid sample consists of an aqueous dispersion of nanoparticles with an inert diluent material dissolved (such as lactose or mannitol), the collected product will be a diluent containing particles of embedded nanoparticulate drug (e.g. , lactose or mannitol). The final size of the collected product can be controlled and depends on the concentration of nanoparticulate drug and/or diluent in the liquid sample, as well as the size of the droplets produced by the spray dryer nozzle. The assembled product can be used in conventional DPIs for pulmonary or nasal delivery, dispersed in propellants used in pMDIs, or the particles can be reconstituted in water for use in nebulizers. .

In some instances it may be desirable to add an inert carrier to the spray dried material to improve the metrological properties of the final product. This can be especially the case when the spray-dried powder is very small (less than about 5 microns) or when the intended dose is so small that it becomes difficult to meter the dose. Generally, such carrier particles (also known as fillers) are too large to be delivered to the lungs, but simply impact the mouth and throat and are swallowed. Such carriers typically consist of sugars such as lactose, mannitol or trehalose. Other inert materials can also serve as carriers, including polysaccharides and cellulosics.

Spray-dried powders containing particles of nanoparticulate drug can be used in conventional DPIs, dispersed in propellants for use in pMDIs, or reconstituted in liquid media for use with nebulizers.

For compounds that are denatured or destabilized by heat, such as compounds with low melting points (i.e., about 70 to about 150° C.), or for biologics, for example, sublimation can be used to produce dry powder nanoparticulate drug compositions. preferred over evaporation to obtain This is because sublimation avoids the high process temperatures associated with spray drying. In addition, freeze-drying or sublimation, also known as freeze-drying, can enhance the storage properties of drug compounds, particularly for biologics. Freeze-dried particles can also be reconstituted and used in nebulizers. Aggregates of freeze-dried nanoparticle drug particles can be mixed with dry powder intermediates or used alone in DPIs and pMDIs for either nasal or pulmonary delivery.

Sublimation involves freezing the product and subjecting the sample to a strong vacuum. This allows the formed ice to transform directly from the solid state to the vapor state. Such processes are highly efficient and thus provide greater yields than spray drying. The resulting freeze-dried product contains drug and modifier. The drug typically exists in an aggregated state and is used alone for inhalation (pulmonary or nasal), with a diluent material (lactose, mannitol, etc.) in a DPI or pMDI, or for use in a nebulizer. can be reconfigured to

<Liposome composition>
In some embodiments, the pirfenidone or pyridone analog compounds disclosed herein can be prepared into liposomal particles, which can then be aerosolized for inhalation delivery. Lipids useful in the present invention can be any of a variety of lipids, including both neutral lipids and charged lipids. Carriers with desired properties can be prepared using appropriate combinations of lipids, targeting groups, and circulation enhancers. Additionally, the compositions provided herein can be in the form of liposomes or lipid particles (preferably lipid particles). As used herein, the term "lipid particle" refers to a lipid bilayer carrier that "coates" nucleic acids and has little or no aqueous interior. More specifically, the term includes self-assembling lipids in which a portion of the inner layer comprises cationic lipids that form ionic bonds or pairs with negative charges on nucleic acids (e.g., plasmid phosphodiester backbones) Used to describe a bilayer carrier. The inner layer can also include neutral or fusogenic lipids, and in some embodiments, negatively charged lipids. The outer layer of the particle typically comprises a mixture of hydrophobic tails of the inner layer and lipids oriented in a tail-to-tail fashion (as in liposomes). The polar headgroups present on the lipids of the outer layer form the outer surface of the particle.

Liposomal bioactive agents can be designed to have sustained therapeutic efficacy or lower toxicity, allowing for less frequent administration and enhanced therapeutic index. Liposomes are composed of bilayers that entrap the desired pharmaceutical agent. They can be configured as concentric, bilayered, multilamellar vesicles with pharmaceutical agents entrapped in either the lipids of the different layers or the aqueous spaces between the layers.

By way of non-limiting example, lipids used in the compositions can be synthetic, semi-synthetic, or naturally occurring, including phospholipids, tocopherols, steroids, fatty acids, glycoproteins such as albumin, negatively charged lipids and cationic lipids. It may be lipid. Phospholipids include egg phosphatidylcholine (EPC), egg phosphatidylglycerol (EPG), egg phosphatidylinositol (EPI), egg phosphatidylserine (EPS), phosphatidylethanolamine (EPE), and egg phosphatidic acid (EPA); Soy phosphatidylcholine (SPC); SPG, SPS, SPI, SPE, and SPA; hydrogenated egg and soy counterparts (e.g., HEPC, HSPC) at positions 2 and 3 of glycerol containing 12 to 26 carbon atoms. Other phospholipids composed of chains of different headgroups at one position of glycerol, including ester linkages of fatty acids and choline, glycerol, inositol, serine, ethanolamine, as well as the corresponding phosphatidic acid. The chains on these fatty acids can be saturated or unsaturated, and phospholipids can be composed of fatty acids of different chain lengths and different degrees of unsaturation. In particular, the composition of the formulation may include dipalmitoylphosphatidylcholine (DPPC), a major component of naturally occurring pulmonary surfactants, as well as dioleoylphosphatidylcholine (DOPC) and dioleoylphosphatidylglycerol (DOPG). Other examples are dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylglycerol (DMPG), dipalmitoylphosphatidcholine (DPPC) and dipalmitoylphosphatidylglycerol (DPPG), distearoylphosphatidylcholine (DPPS) Phosphatidylglycerol (DSPG), dioleylphosphatidylethanolamine (DOPE) and mixed phospholipids such as palmitoylstearoylphosphatidylcholine (PSPC) and palmitoylstearoylphosphatidylglycerol (PSPG) and mono-oleoyl-phosphatidylethanol It contains a single acylated phospholipid such as an amine (MOPE).

In a preferred embodiment, PEG-modified lipids are incorporated into the compositions of the invention as anti-aggregation agents. The use of PEG-modified lipids places bulky PEG groups on the surface of liposomes or lipid carriers, preventing binding of DNA to the exterior of the carrier (thereby inhibiting cross-linking and aggregation of the lipid carrier). The use of PEG-ceramide is often preferred and has the added benefit of stabilizing membrane bilayers and extending circulation lifetime. In addition, PEG-ceramide can be prepared with different lipid tail lengths to control the longevity of PEG-ceramide in the lipid bilayer. In this way, "programmable" release can be achieved, resulting in controlled lipid-carrier fusion. For example, PEG-ceramide with a C ₂₀ -acyl group attached to the ceramide moiety diffuses out of a lipid bilayer carrier with a half-life of 22 hours. PEG-ceramides with C ₁₄ - and C ₈ -acyl groups diffuse out of the carrier with half-lives of less than 10 minutes and 1 minute, respectively. As a result, the selection of lipid tail length provides compositions in which the bilayer becomes destabilized (and thus fusogenic) at a known rate. Although less preferred, other PEG-lipid or lipid-polyoxyethylene conjugates are useful in the present composition. Examples of suitable PEG-modified lipids are PEG-modified phosphatidylethanolamines and phosphatidic acids, PEG-modified diacylglycerols and dialkylglycerols, PEG-modified dialkylamines and PEG-modified 1, Contains 2-diacyloxypropan-3-amine. Particularly preferred are PEG-ceramide conjugates (eg, PEG-Cer-C ₈ , PEG-Cer-C ₁₄ or PEG -Cer-C ₂₀ ).

Compositions of the invention can be prepared to provide liposome compositions that are about 50 nm to about 400 nm in diameter. Those skilled in the art will appreciate that the size of the composition can be larger or smaller depending on the volume to be encapsulated. Thus, for larger volumes the size distribution is typically from about 80 nm to about 300 nm.

<Surface modifier>
The pirfenidone or pyridone analog compounds disclosed herein can be prepared in pharmaceutical compositions with suitable surface modifiers that can be selected from known organic and inorganic pharmaceutical excipients. Such excipients include low molecular weight oligomers, polymers, surfactants and natural products. Preferred surface modifiers include nonionic and ionic surfactants. Two or more surface modifiers can be used in combination.

Representative examples of surface modifiers include cetylpyridinium chloride, gelatin, casein, lecithin (phospholipids), dextran, glycerol, gum arabic, cholesterol, tragacanth, stearic acid, benzalkonium chloride, calcium stearate, and glycerol monostearate. , cetostearyl alcohol, cetomacrogol emulsifying wax, sorbitan esters, polyoxyethylene alkyl ethers (e.g., macrogol ethers such as cetomacrogol 1000), polyoxyethylene castor oil derivatives, polyoxyethylene sorbitan fatty acid esters (e.g., Tween 20 (ICI Specialty Chemicals)); polyethylene glycols (e.g. Carbowax 3350™ and 1450™, and Carbopol 934™ (Union Carbide)), dodecyltrimethylammonium bromide, polyoxyethylene stearate, colloidal silicon dioxide, phosphate, sodium dodecyl sulfate, carboxymethylcellulose calcium, hydroxypropylcellulose (HPC, HPC-SL and HPC-L), hydroxypropylmethylcellulose (HPMC), sodium carboxymethylcellulose, methylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, hydroxypropylmethylcellulose phthalate, amorphous cellulose, magnesium aluminum silicate, triethanolamine, polyvinyl alcohol (PVA), polyvinylpyrrolidone (PVP), 4-(1,1,3,3-tetaamethylbutyl)-phenolic polymers with ethylene oxide and formaldehyde (also known as tyloxapol, superione, and triton), poloxamers (e.g. Pluronics F68™, and F108™, which are block copolymers of ethylene oxide and propylene oxide); is a tetrafunctional block copolymer (BA SF Wyandotte Corporation, Parsippany, N.W. J. )) charged phospholipids such as dimyristoylphosphatidylglycerol, docusate (DOSS); Tetronic 1508™; (T-1508) (BASF Wyandotte Corporation), dialkyl esters of sodium sulfosuccinic acid (e.g. Aerosol OT™, which is the dioctyl ester of sodium sulfosuccinate (American Cyanamid); Duponol P™ (DuPont), which is sodium lauryl sulfate; Tritons X-200™, which is an alkylaryl polyether sulfonate. ) (Rohm and Haas); Crodestas F-110™ (Croda Inc.), a mixture of sucrose stearate and sucrose distearate; Olin-log™, also known as Surfactant 10-G™ p-isononylphenoxy poly-(glycidol) (Olin Chemicals, Stamford, Conn.); Crodestas SL-40™ (Croda, Inc.); and _C 18 H ₃₇ CH ₂ (CON-CH ₂ (CHOH) SA9OHCO (Eastman Kodak Co.) which is ₄ (CH ₂ OH) ₂ ; decanoyl-N-methylglucamide; n-decyl β-D-glucopyranoside; n-decyl β-D-maltopyranoside; n-dodecyl β-D- n-dodecyl β-D-maltoside; heptanoyl-N-methylglucamide; n-heptyl-β-D-glucopyranoside; n-heptyl β-D-thioglucoside; n-hexyl β-D-glucopyranoside; n-noyl β-D-glucopyranoside, octanoyl-N-methylglucamide, n-octyl-β-D-glucopyranoside, octyl β-D-thioglucopyranoside, and the like. , is a particularly preferred surface modifier for pulmonary or intranasal delivery of steroids, even more so for aerosol therapy.

Examples of surfactants used in the solutions disclosed herein include, but are not limited to, ammonium laureth sulfate, cetamine oxide, cetrimonium chloride, cetyl alcohol, cetyl myristate, cetyl palmitate, cocamide DEA, cocamidopropyl betaine, cocamidopropylamine oxide, cocamide MEA, DEA lauryl sulfate, di-stearyl phthalamide, dicetyldimethylammonium chloride, dipalmitoylethylhydroxyethylmonium, disodium laureth sulfosuccinate, di(hydrogen tallow phthalic acid, glyceryl dilaurate, glyceryl distearate, glyceryl oleate, glyceryl stearate, isopropyl myristate nf, isopropyl palmitate nf, lauramide DEA, laurylamide MEA, oxidation Laurylamide, myristamine oxide, octyl isononanoate, octyl palmitate, octyldodecyl neopentanoate, olealkonium chloride, PEG-2 stearate, PEG-32 glyceryl caprylate/caprate, PEG-32 glyceryl stearate. , PEG-4 and PEG-150 stearates and distearates, PEG-4 to PEG-150 laurates and dilaurates, PEG-4 to PEG-150 oleates and dioleates, PEG-7 glyceryl cocoate, PEG-8 beeswax, propylene stearate Glycol, sodium C14-16 olefin sulfonate, sodium lauryl sulfoacetate, sodium lauryl sulfate, sodium trideceth sulfate, stearalkonium chloride, stearamide oxide, TEA dodecylbenzene sulfonate, TEA lauryl sulfate.

Most of these surface modifiers are known as pharmaceutical excipients and are described in the Handbook of Pharmaceutical Excipients, co-published by the American Pharmaceutical Association and the Pharmaceutical Society of Great Britain. The Pharmaceutical Press, 1986), which is specifically incorporated by reference. Surface modifiers are commercially available and/or can be prepared by techniques known in the art. The relative amounts of drug and surface modifiers can vary widely, the optimal amount of surface modifier being, for example, the particular drug and surface modifier selected, the critical micelle concentration of the surface modifier for forming micelles. , the hydrophilic-lipophilic-balance (HLB) of the surface modifier, the melting point of the surface modifier, the water solubility of the surface modifier and/or the drug, the surface tension of the aqueous solution of the surface modifier, and the like.

In the present invention, the optimal ratio of drug to surface modifier is up to 0.1% to up to 99.9% pirfenidone or pyridone analog compound, more preferably about 10% to 90%.

<Microsphere>
The microspheres can be used for pulmonary delivery of pirfenidone or pyridone analog compounds by first adding an appropriate amount of the drug compound solubilized in water. For example, aqueous pirfenidone or pyridone analog compound solutions were pre-determined for poly(DL-lactide-co-glycolide) (PLGA) by probe sonication for 1-3 minutes on an ice bath. can be dispersed in methylene chloride containing an appropriate amount (0.1-1% w/v). Separately, pirfenidone or pyridone analog compounds can be solubilized in methylene chloride containing PLGA (0.1-1% w/v). The resulting water-in-oil colostrum or polymer/drug solution was lysed from 1-2% polyvinyl alcohol (previously cooled to 4° C.) by probe sonication on an ice bath for 3-5 minutes. dispersed in an aqueous continuous phase consisting of The resulting emulsion is continuously stirred at room temperature for 2-4 hours to evaporate the methylene chloride. The microparticles thus formed are separated from the continuous phase by centrifugation at 8000-10000 rpm for 5-10 minutes. The precipitated particles are washed three times with distilled water and lyophilized. The lyophilized pirfenidone or pyridone analogue compound microparticles are stored at -20°C.

By way of non-limiting example, a spray-drying technique is used to prepare microspheres of pirfenidone or pyridone analog compounds. An appropriate amount of pirfenidone or pyridone analog compound is solubilized in methylene chloride containing PLGA (0.1-1%). This solution is spray dried to obtain microspheres.

By way of non-limiting example, microparticles of pirfenidone or pyridone analogue compounds can be prepared according to size distribution (requirements: 90%<5 μm, 95%<10 μm), shape, drug loading effect and drug Characterized for emission.

By way of non-limiting example, this approach also applies to solids (AUC shape-enhancing formulations, such as low-solubility pirfenidone or pyridone analog compounds or salt forms for nanoparticle-based formulations). can be used to sequester and improve the water solubility of A specified amount of the pirfenidone or pyridone analogue compound was first diluted in 96% ethanol, the minimum amount necessary to keep the fluoroquinolone in solution when diluted with 96 to 75% water. can be dissolved in This solution is then diluted with water to obtain a 75% ethanolic solution, then a certain amount of paracetamol can be added to obtain the following w/w drug/polymer ratio: 1:2, 1:1, 2:1, 3:1, 4:1, 6:1, 9:1, and 19:1. These final solutions are spray dried under the following conditions: feed rate (15 mL/min); inlet temperature, 110° C.; outlet temperature, 85° C.; pressure, 4 bar, and drying air throughput, 35 m/min. hr. The powder is then collected and stored under vacuum in a dessiccator.

<Solid lipid particles>
Solid lipid particle formulations of pirfenidone or pyridone analogue compounds are prepared by dissolving the drug in a lipid solubilizer (phospholipids such as phosphatidylcholine and phosphatidylserine) maintained at least at the melting temperature of the lipid, followed by at least the melting temperature of the lipid. can involve dispersing the drug-containing lysate in a warm aqueous surfactant solution (typically 1-5% w/v) maintained at . The coarse dispersion is homogenized for 1-10 minutes using a Microfluidizer® to obtain a nanoemulsion. Cooling the nanoemulsion to a temperature between 4-25° C. again solidifies the lipids, resulting in the formation of solid lipid nanoparticles. Optimization of formulation parameters (lipid matrix type, surfactant concentration, and production parameters) is performed to achieve prolonged drug delivery. By way of non-limiting example, this approach also sequesters and improves the aqueous solubility of solids (low solubility pirfenidone or pyridone analog compounds or AUC form-enhanced formulations such as salt forms for nanoparticle-based formulations). can be used for

<AUC Shape of Melt Extrusion-Enhanced Formulation>
Formulations of pirfenidone or pyridone analogue compounds that enhance the AUC shape of melt extrusion can be accomplished by adding surfactants or preparing microemulsions, forming inclusion complexes with other molecules such as cyclodextrins. , by dissolving the drug in micelles, by forming nanoparticles of the drug, or by embedding amorphous drug in a polymer matrix. Homogeneous embedding of the drug in the polymer matrix results in a solid dispersion. Solid dispersions can be prepared in two ways: the solvent method and the hot melt method. The solvent method uses an organic solvent in which the drug and suitable polymer are dissolved and then (spray) dried. The main drawbacks of this method are the use of organic solvents and the batch mode production process. Hot melt methods use heat to disperse or dissolve a drug in a suitable polymer. The melt extrusion process is an optimized version of the hot melt method. Advantages of the melt extrusion approach are the lack of organic solvents and continuous production processes. Since melt extrusion is a new pharmaceutical technology, the literature dealing with it is limited. The technical configuration comprises, by way of non-limiting example, the pirfenidone or pyridone analog compound hydroxypropyl-b-cyclodextrin (HP-b -CD), and hydroxypropyl methylcellulose (HPMC) mixing and extrusion. Cyclodextrins are ring-shaped molecules with hydroxyl groups on the outer surface and a cavity in the center. Cyclodextrins sequester drugs through the formation of inclusion complexes. Complex formations between cyclodextrins and drugs have been extensively investigated. Water-soluble polymers are known to interact with cyclodextrin and drug during complex formation to form stable complexes of drug and cyclodextrin co-complexed with the polymer. . This complex is more stable than classical cyclodextrin drug complexes. As an example, HPMC is water soluble; therefore, use of this polymer with HP-b-CD in the lysate is expected to create an aqueous soluble AUC shape-enhancing formulation. By way of non-limiting example, this approach also sequesters and improves the aqueous solubility of solids (AUC shape-enhanced formulations, such as low-solubility pirfenidone or pyridone analog compounds or salt forms for nanoparticle-based formulations). can be used to

<Coprecipitate>
Co-precipitate Pirfenidone or pyridone analog compound formulations may be prepared by forming a co-precipitate with a pharmacologically inert polymeric material. Formation of molecular solid dispersions or co-precipitates to create AUC-shaped enhanced formulations with various water-soluble polymers can be used to determine their in vitro dissolution rates and/or in vivo absorption. It has been demonstrated that it can be significantly slowed down. Grinding is commonly used to reduce the particle size when preparing powdered products, as dissolution rates are strongly influenced by particle size. In addition, strong forces (such as crushing) can increase surface energy and cause crystal lattice distortion as well as grain size reduction. Co-milled drug with hydroxypropylmethylcellulose, b-cyclodextrin, chitin, and chitosan, microcrystalline cellulose, and gelatin have been shown to enhance AUC shape for readily bioavailable pirfenidone or pyridone analog compounds. may enhance dissolution properties such that By way of non-limiting example, this approach also sequesters and improves the aqueous solubility of solids (AUC shape-enhanced formulations, such as low-solubility pirfenidone or pyridone analog compounds or salt forms for nanoparticle-based formulations). can be used to

<Peptide that enhances dispersion>
A composition may comprise one or more dipeptides or tripeptides comprising two or more leucine residues. By way of further non-limiting example, US Pat. No. 6,835,372, which discloses dispersion enhancing peptides, is hereby incorporated by reference in its entirety. This patent discloses that di-leucyl-containing dipeptides (eg, dileucine) and tripeptides are superior in their ability to increase the dispersibility of powdered compositions.

In another embodiment, highly dispersible particles comprising amino acids are administered. Hydrophobic amino acids are preferred. Suitable amino acids include naturally occurring and non-naturally occurring hydrophobic amino acids. Some naturally occurring hydrophobic amino acids, including but not limited to non-naturally occurring amino acids, include, for example, beta-amino acids (arnino acids). Both D, L and racemic configurations of hydrophobic amino acids can be utilized. Suitable hydrophobic amino acids may also include amino acid analogs. As used herein, amino acid analogs include the D or L configuration of amino acids having the following formula: --NH--CHR--CO--, where R is an aliphatic group , a substituted aliphatic group, a benzyl group, a substituted benzyl group, an aromatic group or a substituted aromatic group, wherein R does not correspond to a side chain of a naturally occurring amino acid. As used herein, an aliphatic group includes a fully saturated straight chain, branched chain, or cyclic C1-C8 hydrocarbon, which contains one or more of nitrogen, oxygen, sulfur, etc. It contains two heteroatoms and/or contains one or more units of desaturation. Aromatic groups include carbocyclic aromatic groups such as phenyl and naphthyl, and heterocyclic groups such as imidazolyl, indolyl, thienyl, furanyl, pyridyl, pyranyl, oxazolyl, benzothienyl, benzofuranyl, quinolinyl, isoquinolinyl and acridintyl. contains an aromatic group of

Suitable substituents on aliphatic, aromatic and benzyl groups include --OH, halogen (--Br, --Cl, --I, and --F)--O (aliphatic, substituted aliphatic group, benzyl group, substituted benzyl group, aryl group, or substituted aryl group), --CN, --NO ₂ , --COOH, --NH ₂ , --NH (aliphatic group, substituted aliphatic group, benzyl group, substituted benzyl group, aryl group, or substituted aryl group), --N (aliphatic group, substituted aliphatic group, benzyl group, substituted benzyl group, aryl group, or substituted aryl group) ₂ , --COO (aliphatic group, substituted aliphatic group, benzyl group, substituted benzyl group, aryl group, or substituted aryl group), --CONH ₂ , --CONH (aliphatic group, substituted aliphatic group, benzyl group, substituted benzyl group, aryl group, or substituted aryl group), --SH, --S (aliphatic group, substituted aliphatic group, benzyl group, substituted benzyl aromatic groups, or substituted aromatic groups), and --NH--C(.dbd.NH)-- _NH2 . A substituted benzylic or aromatic group can also have an aliphatic or substituted aliphatic group as a substituent. A substituted aliphatic group can also have a benzyl group, a substituted benzyl group, an aryl group, or a substituted aryl group as a substituent. A substituted aliphatic group, a substituted aromatic group, or a substituted benzyl group can have one or more substituents. Modification of amino acid substituents can, for example, increase the lipophilicity or hydrophobicity of naturally occurring amino acids that are hydrophilic.

Many suitable amino acids, amino acid analogs, and salts thereof can be obtained commercially. Others can be synthesized by methods known in the art.

Hydrophobicity is generally defined in terms of the partitioning of amino acids between non-polar solvents and water. Hydrophobic amino acids are acids that favor non-polar solvents. The relative hydrophobicity of amino acids can be expressed on the hydrophobicity scale, where glycine has a value of 0.5. On such a scale, amino acids with a preference for water have values below 0.5 and those with a preference for non-polar solvents have values above 0.5. As used herein, the term hydrophobic amino acid has a value on the hydrophobicity scale greater than or equal to 0.5, in short a nonpolar amino acid at least equal to that of glycine. acid.

Examples of amino acids that may be utilized include, but are not limited to, glycine, proline, alanine, cysteine, methionine, valine, leucine, tyosine, isoleucine, phenylalanine, tryptophan. Preferred hydrophobic amino acids include leucine, isoleucine, alanine, valine, phenylalanine, and glycine. Combinations of hydrophobic amino acids can also be used. Additionally, combinations of hydrophobic and hydrophilic (preferentially partitioning in water) amino acids can be utilized, with the overall combination being hydrophobic.

Amino acids may be present in the particles of the invention in an amount of at least 10% by weight. Preferably, the amino acid can be present in the particles in amounts ranging from about 20 to about 80% by weight. Salts of hydrophobic amino acids may be present in the particles of the invention in an amount of at least 10 weight percent. Preferably, the amino acid salt is present in the particles in amounts ranging from about 20 to about 80% by weight. In preferred embodiments, the particles have a tap density of less than about 0.4 g/ ^cm3 .

A method for forming and delivering particles comprising amino acids is described in U.S. Pat. No. 6,586,008, entitled "Use of Simple Amino Acids to Form Porous Particles During Spray Drying," the teachings of which are incorporated herein by reference. incorporated herein by.

<Protein/Amino Acid>
Protein excipients may include albumins such as human serum albumin (HSA), recombinant human albumin (rHA), gelatin, casein, hemoglobin and the like. Suitable amino acids (external to the dileucyl peptides of the invention) may also function in buffering capacity and include alanine, glycine, arginine, betaine, histidine, glutamic acid, aspartic acid, cysteine, lysine, leucine, isoleucine, valine, methionine, Including phenylalanine, aspartame, tyrosine, tryptophan, etc. Amino acids and polypeptides that function as dispersants are preferred. Amino acids that fall into this category include hydrophobic amino acids such as leucine, valine, isoleucine, tryptophan, alanine, methionine, phenylalanine, tyrosine, histidine, and proline. Dispersibility-enhancing peptide excipients include dimers, trimers, tetramers, and pentamers containing one or more hydrophobic amino acid building blocks such as those described above.

<Carbohydrate>
By way of non-limiting example, carbohydrate excipients include monosaccharides such as fructose, maltose, galactose, glucose, D-mannose, sorbose; disaccharides such as lactose, sucrose, trehalose, cellobiose; Polysaccharides such as dextran, starch; and alditols such as mannitol, xylitol, maltitol, lactitol, xylitol sorbitol (glucitol), pyranosyl sorbitol, myoinositol, isomalt, trehalose.

<Polymer>
By way of non-limiting example, the composition may also contain polymeric excipients/additives (e.g., polyvinylpyrrolidone), derivatized celluloses such as hydroxymethylcellulose, hydroxyethylcellulose, and hydroxypropylmethylcellulose, Ficoll (a polymeric sugar), Hydroxyethyl starch, dextrates (by non-limiting example, cyclodextrins are 2-hydroxypropyl-beta-cyclodextrin, 2-hydroxypropyl-gamma-cyclodextrin, randomly methylated beta-cyclo Dextrin, dimethyl-alpha-cyclodextrin, dimethyl-beta-cyclodextrin, maltosyl-alpha-cyclodextrin, glucosyl-1-alpha-cyclodextrin, glucosyl-2-alpha-cyclodextrin, alpha-cyclodextrin, beta-cyclodextrin , gamma-cyclodextrin, and sulfobutyl ether-beta-cyclodextrin), polyethylene glycol, and pectin may also be used.

The highly dispersible particles to be administered comprise bioactive agents and comprise biocompatible, preferably biodegradable polymers, copolymers, or mixtures. Polymers can be combined to optimize different characteristics of the particles, including: i) the combination of the drug to be delivered and the polymer to provide drug stability and retention of activity during delivery; ii) rate of polymer degradation and hence drug release properties; iii) surface properties and targeting capabilities through chemical modification; and iv) particle porosity.

Surface eroding polymers such as polyanhydrides can be used to form the particles. For example, polyanhydrides such as poly[(p-carboxyphenoxy)hexane anhydride] (PCPH) can be used. Biodegradable polyanhydrides are described in US Pat. No. 4,857,311. Bulk eroding polymers can also be used, such as those based on polyesters containing poly(hydroxy acids). For example, polyglycolic acid (PGA), polylactic acid (PLA) or copolymers thereof can be used to form the particles. Polyesters can also have groups that can be charged or functionalized, such as amino acids. In a preferred embodiment, the particles with controlled release properties incorporate a surfactant such as dipalmitoylphosphatidylcholine (DPPC), poly(D,L-lactic acid) and/or poly(DL-lactic-co-glycolic acid) (PLGA).

Other polymers include polyamides, polycarbonates, polyalkylenes such as polyethylene, polypropylene, poly(ethylene glycol), poly(ethylene oxide), poly(ethylene terephthalate), polyvinyl compounds such as polyvinyl alcohol, polyvinyl ethers, and polyvinyl esters, acrylics and Including polymers of methacrylic acid, cellulose and other polysaccharides, and peptides or proteins, or copolymers or mixtures thereof. Polymers can be selected or modified to have appropriate stability and degradation rates in vivo for different controlled drug delivery applications.

Highly dispersible particles are described by Hrkach et al. , Macromolecules, 28: 4736-4739 (1995); and Hrkach et al. ， ”Ｐｏｌｙ（Ｌ－Ｌａｃｔｉｃ ａｃｉｄ－ｃｏ－ａｍｉｎｏ ａｃｉｄ） Ｇｒａｆｔ Ｃｏｐｏｌｙｍｅｒｓ： Ａ Ｃｌａｓｓ ｏｆ Ｆｕｎｃｔｉｏｎａｌ Ｂｉｏｄｅｇｒａｄａｂｌｅ Ｂｉｏｍａｔｅｒｉａｌｓ” ｉｎ Ｈｙｄｒｏｇｅｌｓ ａｎｄ Ｂｉｏｄｅｇｒａｄａｂｌｅ Ｐｏｌｙｍｅｒｓ ｆｏｒ Ｂｉｏａｐｐｌｉｃａｔｉｏｎｓ， ＡＣＳ Ｓｙｍｐｏｓｉｕｒｎ Ｓｅｒｉｅｓ Ｎｏ． 627, Raphael M, Ottenbrite et al. , Eds. , American Chemical Society, Chapter 8, pp. 93-101, 1996, from functionalized polyester graft copolymers.

In a preferred embodiment of the invention, highly dispersible particles containing bioactive agents and phospholipids are administered. Examples of suitable phospholipids include phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylserine, phosphatidylinositol, and combinations thereof, among others. Specific examples of phospholipids include, but are not limited to, phosphatidylcholine dipalmitoylphosphatidylcholine (DPPC), dipalmitoylphosphatidylethanolamine (DPPE), distearoylphosphatidylcholine (DSPC), dipalmitoylphosphatidylglycerol (DPPG), or any thereof. including combinations of Other phospholipids are known to those skilled in the art. In preferred embodiments, the phospholipid is endogenous to the lung.

Phospholipids can be present in the particles in amounts ranging from about 0 to about 90% by weight. More generally, phospholipids can be present in the particles in amounts ranging from about 10 to about 60% by weight.

In another embodiment of the invention, the phospholipids or combinations thereof are selected to impart controlled release properties to the highly dispersible particles. The phase transition temperature of certain phospholipids may be below, about the same as, or above the patient's physiological body temperature. Preferred phase transition temperatures range from 30° C. to 50° C. (eg, within +/-10° C. of the patient's normal body temperature). By selection of the phospholipid or combination of phospholipids according to the phase transition temperature, the particles can be tailored to have controlled release properties. For example, the release of dopamine precursors, agonists or any combination of precursors and/or agonists can be slowed by administration of particles comprising a phospholipid or combination of phospholipids having a phase transition temperature above the patient's body temperature. On the other hand, rapid release can be obtained by including phospholipids in the particles with lower transition temperatures.

<Correcting, Flavoring, Others>
As also noted above, the pirfenidone or pyridone analog compound formulations and related compositions disclosed herein may contain one or more flavoring agents, such as flavoring agents, inorganic salts (e.g., sodium chloride), Sweeteners, antioxidants, antistatic agents, surfactants (e.g., polysorbates such as "TWEEN 20" and "TWEEN 80"), sorbitan esters, saccharin (e.g., as indicated elsewhere herein). sodium saccharin, other forms of saccharin), bicarbonates, cyclodextrins, lipids (e.g., lecithin and other phospholipids such as phosphatidylcholine, phosphatidylethanolamine), fatty acids and fatty acid esters, steroids (eg, cholesterol), and chelating agents (eg, EDTA, zinc, and other such suitable cations). Other pharmaceutical excipients and/or additives suitable for use in compositions according to the invention are described in "Remington: The Science & Practice of Pharmacy", 19th ed. , Williams & Williams, (1995), and in the "Physician's Desk Reference", 52nd ed. , Medical Economics, Montvale, N.L. J. (1998)”.

By way of non-limiting example, flavoring agents in formulations of pirfenidone or pyridone analog compounds include flavoring agents, sweeteners, and various other coating strategies (e.g., sugars such as sucrose, dextrose, and lactose). , carboxylic acids, menthol, amino acids, amino acid derivatives such as arginine, lysine, and sodium glutamate, and/or artificial flavoring oils, flavorings and/or natural oils, extracts from plants, leaves, flowers, fruits, etc., and This may include the use of combinations thereof, these include citrus oils such as cinnamon oil, wintergreen oil, peppermint oil, clover oil, bay oil, anise oil, eucalyptus, vanilla, lemon oil, orange oil, grape and grapefruit oil. , apples, peaches, pears, strawberries, raspberries, cherries, plums, pineapples, apricots, etc. Additional sweeteners include sucrose, dextrose, aspartame (Nutrasweet®), acesulfame-K , sucralose and saccharin (e.g., sodium saccharin, which may be present in certain embodiments at certain concentrations or in certain molecular ratios to compounds of pyridone analogs such as pirfenidone, as shown elsewhere herein) , or other forms of saccharin), organic acids (by non-limiting examples, citric acid and aspartic acid) Such flavoring agents are present at from about 0.05 to about 4 weight percent, based on the flavoring agent. one or more factors of potency, solubility of flavorants, effect of flavorants on solubility, or other physicochemical or pharmacokinetic properties of other formulation components, or as other factors, more It can be present in lower or higher amounts.

Another approach to ameliorate or mask the unpleasant taste of inhaled drugs is to reduce the drug's solubility, eg, the drug must dissolve to interact with taste receptors. Thus, delivering a solid form of the drug may avoid taste responses and provide the desired improved taste effect. Non-limiting methods for reducing the solubility of pirfenidone or pyridone analog compounds include, for example, conjugation with pyridone analogs such as xinafoic acid, oleic acid, stearic acid, and/or pamoic acid. are described herein through the use in the formulation of certain salt forms of the compounds of Additional co-precipitants include dihydropyridines and polymers such as polyvinylpyrrolidone.

Additionally, taste masking can be achieved by the production of lipophilic vesicles. Additional coating or capping agents include dextrin (by non-limiting example, cyclodextrins are 2-hydroxypropyl-beta-cyclodextrin, 2-hydroxypropyl-gamma-cyclodextrin, randomly methylated beta -cyclodextrin, dimethyl-alpha-cyclodextrin, dimethyl-beta-cyclodextrin, maltosyl-alpha-cyclodextrin, glucosyl-1-alpha-cyclodextrin, glucosyl-2-alpha-cyclodextrin, alpha-cyclodextrin, beta- modified celluloses such as ethyl cellulose, methyl cellulose, hydroxypropyl cellulose, hydroxyl propyl methyl cellulose, polyalkylene glycols, polyalkylene oxides, sugars and sugar alcohols. , waxes, shellacs, acrylics, and mixtures thereof. By way of non-limiting example, other methods of delivering an undissolved form of a Pirfenidone or Pyridone Analog Compound according to certain embodiments or, in other embodiments, an undissolved form of a Pirfenidone or Pyridone Analog Compound are: , alone or in simple, non-solubility affecting formulations such as micronized crystals, dry powders, spray-dried, and/or nanosuspension formulations. That is.

An alternative according to certain other preferred embodiments is to include a taste-modifying agent in the formulation of the pirfenidone or pyridone analog compound. These embodiments contemplate including in the formulation a flavoring agent mixed with, coated on, or combined with the active drug pirfenidone or pyridone analog compound or salt thereof. Inclusion of one or more such agents in these formulations also improves the taste of the pharmacologically active compound that is included in the formulation in addition to the pirfenidone (e.g., mucolytic agent) or pyridone analog compound. can play a role in Non-limiting examples of such taste modifiers include acidic phospholipids, lysophospholipids, tocopherol polyethylene glycol succinate, and embonic acid (pamoate). Many of these agents can be used alone or in combination with pirfenidone or pyridone analog compounds (or salts thereof) or, in separate embodiments, in combination with pirfenidone or pyridone analog compounds for aerosol administration. .

<mucolytic agent>
Methods of producing formulations that combine agents that reduce sputum viscosity during aerosol treatment with pirfenidone or pyridone analogue compounds include the following. These agents may be prepared in a fixed combination or administered sequentially with an aerosol pirfenidone or pyridone analog compound treatment.

The most commonly prescribed drug is N-acetylcysteine (NAC), which depolymerizes mucus in vitro by breaking disulfide bridges between macromolecules. Such a reduction in saliva stickiness is hypothesized to facilitate its removal from the respiratory tract. Additionally, NAC can act as an oxygen radical scavenger. NAC can be obtained either orally or by inhalation. Differences between these two methods of administration have not been formally studied. After oral administration, NAC is reduced to cysteine (precursor of the antioxidant glutathione) in the liver and intestine. Antioxidant properties help prevent the decline of lung function in cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), or pulmonary fibrosis diseases (e.g., idiopathic pulmonary fibrosis) obtain. Nebulized NAC is commonly prescribed to patients with CF, especially in continental Europe, to improve saliva expectoration by making it less sticky. The ultimate goal is to slow the decline of lung function in CF.

L-lysine-N-acetylcysteinate (ACC) or Nacystelyn (NAL) is a new mucoactive drug with mucolytic, antioxidant and anti-inflammatory properties. Chemically it is a salt of ACC. This drug appears to exhibit superior activity to its parent molecule ACC due to the synergistic mucolytic activity of L-lysine and ACC. Furthermore, its near-neutral pH (6.2) allows its administration in lungs with a very low incidence of bronchospasm, whereas for acidic ACC (pH 2.2) does not apply. NAL is difficult to formulate in inhaled form because the required lung dose is very high (approximately 2 mg) and the cohesiveness and cohesiveness of the micronized drug, thus making it redispersable. ) is a problem in producing formulations. NAL is the chlorofluorocarbon (CFC), including metered dose inhaler (MDI), because this form was the easiest and fastest to develop to begin preclinical and first clinical studies. was first developed as NAL MDI delivered 2 mg per puff, of which approximately 10% was able to reach the lungs of healthy volunteers. One major inconvenience of this formulation has been patient compliance, as as many as 12 puffs are required to obtain the required dose. Furthermore, the progressive elimination of CFC gases from pharmaceuticals combined with coordination problems experienced by a large portion of the patient population (12) has led to the development of new herbal forms of NAL. Dry powder inhaler (DPI) formulations provide the optimal, replicable, comfortable drug formulation to solve the problem of compliance with MDIs and to administer drugs to the widest possible patient population, including young children. method was chosen to combine

The DPI formulation of NAL involves the use of non-conventional lactose (usually reserved for direct compression of tablets), ie, roller dried (RD) anhydrous β-lactose. When tested in vitro with a monodose DPI device, this powder formulation exhibits a fine particle fraction (FPF) of at least 30% of the nominal dose, i. ). This approach can be used in combination with pirfenidone or pyridone analog compounds for either co-administration or fixed combination therapy.

In addition to mucolytic activity, excessive neutrophil elastase activity in the airways of cystic fibrosis (CF) patients leads to progressive lung injury. Breaking disulfide bonds on elastase by reducing agents can modify its enzymatic activity. Three naturally occurring dithiol reducing systems have been investigated for their effect on elastase activity: 1) the E. coli thioredoxin (Trx) system, 2) the recombinant human thioredoxin (rhTrx) system, and 3) dihydroriboic acid (DHLA). ). The Trx system consisted of Trx, Trx reductase, and NADPH. As shown by spectrophotometric assays of elastase activity, the two Trx systems and DHLA are associated with purified human neutrophils, as well as elastinolytic activity present in the soluble phase (sol) of CF saliva. also inhibited the elastase of Removal of any of the three Trx system components prevented inhibition. Compared to monothiol N-acetylcysteine and reduced glutathione, dithiol showed greater elastase inhibition. To rationalize Trx as an investigational tool, a stable reductant of rhTrx was synthesized and used as a single building block. Reduced rhTrx inhibited purified elastase and CF salivary sol elastase without NADPH or Trx reductase. Because Trx and DHLA have mucolytic effects, we investigated changes in elastase activity after mucolytic treatment. Raw CF saliva was treated directly with reduced rhTrx, Trx system, DHLA, or DNase. The Trx system and DHLA did not increase elastase activity, but reduced rhTrx treatment increased sol elastase activity by 60%. In contrast, elastase activity after DNase treatment increased by 190%. The ability of Trx and DHLA to limit elastase activity combined with their mucolytic effects makes these compounds electrotherapeutic for CF.

In addition, F-actin and DNA bundles present in the saliva of cystic fibrosis (CF) patients, but not in normal airway fluid, inhibit the clearance of infected airway fluid and contribute to CF pathology. Contributing to the altered viscoelastic properties of saliva, aggravating. One approach to alter these inverse properties is to use DNase to enzymatically depolymerize the DNA into its constituent monomers and gelsolin to cleave F-actin into small fragments, thus transforming these filaments. to remove agglomerates of The high density of negative surface charges on DNA and F-actin suggests that bundles of these filaments alone exhibit strong electrostatic repulsion. It can be stabilized by polyvalent cations, such as charged molecules. Furthermore, as a matter of fact, DNA or F-actin bundles formed after the addition of histone H1 or lysozyme are efficiently dissolved by soluble multivalent anions such as polymeric aspartate or glutamate. was observed. Addition of poly-aspartate or poly-glutamate also dispersed bundles containing DNA and actin in CF saliva, increasing the elasticity of these samples to levels comparable to those obtained after treatment with DNase I or gelsolin. reduce the rate. Addition of poly-aspartate also increased DNase activity when added to samples containing DNA bundles formed with histone H1. When added to CF saliva, poly-aspartate significantly reduced bacterial growth, indicating activation of endogenous antimicrobial factors. These findings suggest that soluble polyvalent anions possess potential alone or in combination with other mucolytic agents to selectively separate large bundles of charged biopolymers formed in CF saliva. suggest that

Thus, NAC, unfractionated heparin, reduced glutathione, dithiols, Trx, DHLA, other monothiols, DNAse, dornase alfa, hypertonic preparations (e.g., osmolality greater than about 350 mOsmol/kg), weight Multivalent anions such as coalescing aspartate or glutamate, glycosidases, and other examples mentioned above may have anti-fibrotic and/or anti-inflammatory activity due to their better distribution from reduced salivary viscosity. pirfenidone or pyridone analog compounds for aerosol administration and other mucolytic agents and improved pulmonary function (from improved salivary fluidity and mucociliary clearance) and It can be combined with improved clinical outcome due to reduced lung tissue damage from the immune inflammatory response.

<Characterization of inhalation device>
Efficiency of a particular inhalation device can be evaluated by, among others, analysis of pharmacokinetic properties, measurement of lung deposition rate, measurement of respirable delivered dose (RDD), measurement of consumption rate, geometric standard deviation values ( GSD), and mass median aerodynamic diameter (MMAD).

Methods and systems for interrogating specific inhalation devices are known. One such system consists of a hollow cylinder in a computing means, a pump means with a connecting piece to which an inhalation device is to be connected. In the pump means there is a piston rod extending from a hollow cylinder. The linear drive can be operated in such a manner that one or more breathing patterns are simulated on the connecting piece of the pump means. In order to enable the evaluation of the inhalation device to be performed, the computer is advantageously connected using data transmission means. With the aid of data transmission means, a computer can be connected with another computer using a specific data bank in order to exchange breathing pattern data. In this way, a library of breathing patterns that are as representative as possible can be built up very quickly. US Pat. No. 6,106,479 discloses this method for examining inhalation devices in more detail and is incorporated herein by reference in its entirety.

<Pharmacokinetic properties>
Pharmacokinetics is concerned with the uptake, distribution, metabolism, and secretion of drug substances. Pharmacokinetic characterization includes one or more biological measurements designed to measure drug substance absorption, distribution, metabolism, and secretion. One way of visualizing pharmacokinetic properties is by means of plasma concentration curves, which show mean active ingredient plasma concentration on the Y-axis and time (usually in hours) on the X-axis. It is a graph to draw. Some pharmacokinetic parameters that can be visualized by plasma concentration curves include:
Cmax: maximum plasma concentration in the patient AUC: area under the curve TOE: exposure time T1/2: time taken to reduce the amount of drug in the patient by half _Tmax : to reach the maximum plasma concentration in the patient time of

Pharmacokinetics (PK) relates to the time course of a therapeutic agent, such as the concentration of pirfenidone, or a pyridone analog compound, in the body. Drug potency (PD) relates to the relationship between pharmacokinetics and in vivo efficacy. PK/PD parameters correlate therapeutic agents, such as exposure with effective activity. Thus, predicting the therapeutic efficacy of therapeutic agents, such as by the diverse mechanisms of action of different PK/PD parameters, can be used.

Any standard pharmacokinetic protocol can be used to determine plasma concentration profiles in humans following administration of formulations containing the pirfenidone or pyridone analog compounds described herein, whereby the formulations , to establish whether the pharmacokinetic criteria formulated herein are met. For example, but without limitation, a type of randomized, single-dose crossover study may be utilized using a group of healthy adult human subjects. The number of subjects may be sufficient to provide adequate control for variability in statistical analysis, typically about eight or more, although smaller groups may be used in certain embodiments. In one embodiment, the subject receives a single dose of a test inhalation mixture comprising a pirfenidone or pyridone analog compound at time 0. Blood samples are collected from each subject before dosing and at various intervals after dosing. Plasma can be separated from a blood sample by centrifugation, and the separated plasma can be treated with a method such as that described in, for example, Ramu et al., Journal of Chromatography B, 751:49-59 (2001). Analyzed by a validated high performance liquid chromatography/tandem weight spectrometry (LC/APCI-MS/MS) procedure. In other embodiments, data from a single subject can be collected and used to construct a pK profile and demonstrate enhanced pharmacokinetic properties. In yet other embodiments, suitable in vitro models can be used to construct pK profiles and demonstrate or demonstrate enhanced pharmacokinetic properties.

In some embodiments, human pK profiles can be obtained through the use of relative growth rates. In one embodiment, rat aerosol lung data and plasma delivery are scaled to provide an indication of possible human data. In one embodiment, relative growth rates use the parameters established in the “USA FDA Guidance for industry—Estimating the Maximum Safe Starting Dose in Initial Clinical Trials for Therapeutics in Adult Healthy Volunteers.”

Any aqueous inhalable mixture that confers the desired pharmacokinetic properties may be suitable for administration according to the present methods.

As used herein, the “peak period” of the in vivo concentration of a pharmaceutical agent is defined as the period of administration of the pharmaceutical agent when the concentration of the pharmaceutical agent is at least 50% of its maximum plasma or disease site concentration. Defined as the interval time. In some embodiments, "peak period" is used to describe the interval between doses of a pirfenidone or pyridone analog compound.

In some embodiments, when considering treatment of pulmonary disease, the methods or systems described herein provide at least a two-fold enhancement in pharmacokinetic properties for treatment of pulmonary disease. In some embodiments, the methods and systems described herein provide at least a two-fold enhancement in the pulmonary tissue pharmacokinetic properties of the pirfenidone or pyridone analog compound compared to oral administration.

In some embodiments, delayed appearance of 5-carboxy-pirfenidone (the major pirfenidone liver metabolite) was observed from the methods and systems described herein. In some embodiments, rapid clearance of pirfenidone from lung tissue was observed. A comparison of the initial rapid elimination of pirfenidone from lung tissue and the parallel appearance of pirfenidone in plasma suggests that direct pulmonary administration may be an excellent route for systemic administration of pirfenidone. The delayed appearance of the 5-carboxy-pirfenidone metabolite supports the hypothesis that this metabolite serves as a marker for pirfenidone recycling to the lung and other tissues after direct aerosol administration to the lung. To support. In some embodiments, recycled pirfenidone is likely important in supporting long-term elevated pirfenidone levels in the lungs and other potentially beneficial tissues.

In some embodiments, the amount of pirfenidone or pyridone analog compound administered to a human by inhalation is calculated by measuring the amounts of the pirfenidone or pyridone analog compound and related metabolites found in the urine. can be In some embodiments, about 80% of the pirfenidone administered is secreted into the urine (95% is the primary metabolite, 5-carboxy-pirfenidone). In some embodiments, calculations based on urinary compounds and metabolites are performed over 48 urine collections (after a single dose), thereby determining the amount of pirfenidone or pyridone analog delivered to humans. The total amount of compound is the sum of pirfenidone and its metabolites measured. By way of non-limiting example, 80% of pirfenidone is known to be secreted, and a urine measurement of 50 mg total of pirfenidone and its metabolites translates to a delivered dose of approximately 63 mg (80% 50 mg divided by ). By way of non-limiting example, if the inhaled aerosol fine particle fraction (FPF) is 75%, approximately 75% of the drug is deposited in the lungs (and approximately 25% is swallowed, followed by 80% in the urine). absorbed from the intestine). Combining these two calculations of a delivered dose of 63 mg (as measured by urinary excretion) yields approximately 47 mg of inhaled aerosol pirfenidone delivered to the lungs (actual RDD; calculated as a product of 63 mg and 75% FPF). This RDD can then be used in various calculations, including lung tissue concentrations.

In some embodiments, the methods or systems described herein provide pharmacokinetic properties of the pirfenidone or pyridone analog compounds described herein. In some embodiments, the methods or systems described herein provide pharmacokinetic properties of pirfenidone or pyridone analog compounds as in Examples 6 and 7.

In some embodiments, the efficacy of the pirfenidone or pyridone analog compound in treating pulmonary fibrosis is achieved through continuous administration to humans by inhalation. As shown in Examples 6 and 7, administration of pirfenidone or pyridone analog compounds to humans by inhalation provides higher Cmax levels compared to oral delivery. In some embodiments, solutions of pirfenidone or pyridone analog compounds administered by inhalation provide higher Cmax levels compared to oral delivery. In some embodiments, a peak period is used to define the optimal dosing schedule for the pirfenidone or pyridone analog compound. In some embodiments, the pirfenidone or pyridone analog compound solution is administered more than once a week.

Small intratracheal aerosol doses deliver rapidly cleared high lung Cmax and low AUC. Human, animal, and in vitro studies all show that the pirfenidone effect is dose-responsive (i.e., higher doses are associated with enhanced effect), and Cmax is an important driver in pirfenidone effect. ). While pulmonary Cmax appears to be important for efficacy, more regular pirfenidone exposure also appears to be important for enhancing this effect. In some embodiments, in the context of treating pulmonary disease in humans, more frequent direct pulmonary administration of pirfenidone or pyridone analog compounds results in repeated high Cmax dosing and more regular administration of the active therapeutic agent. benefits can be provided both through the provision of adequate exposure.

In some embodiments, described herein are methods of treating pulmonary disease in a mammal, comprising administering pirfenidone or a pyridone analog compound on a continuous dosing schedule to a mammal in need thereof. administering directly to the lungs of the animal, wherein the observed lung tissue Cmax of the pirfenidone or pyridone analog compound dose is greater than 0.1 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 0.5 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 1.0 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 5 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 10 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 15 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 20 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 25 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 30 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 35 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 40 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 45 mcg/gram of lung tissue. In some embodiments, the lung tissue Cmax observed from the pirfenidone or pyridone analog compound dose is greater than 50 mcg/gram of lung tissue. In some embodiments, the dose comprises an aqueous solution of a pirfenidone or pyridone analog compound. In some embodiments, the dose is administered with a liquid nebulizer. In some embodiments, the pirfenidone or pyridone analog compound is administered more than once a week. In some embodiments, the pirfenidone or pyridone analog compound is administered on a continuous daily dosing schedule. In some embodiments, a single dose of the pirfenidone or pyridone analog compound is administered more than once a week, more than twice a week, more than three times a week, more than four times a week, Administered more than 5 times, more than 6 times a week, or daily.

In some embodiments, described herein are methods of treating pulmonary disease in a mammal, comprising administering pirfenidone or a pyridone analog to a mammal in need thereof on a continuous dosing schedule. Including administering directly to the lung. In some embodiments, a) the lung tissue Cmax of the pirfenidone or pyridone analog compound from a dose administered directly to the lung of the mammal is at least up to 801 mg of the pirfenidone or pyridone analog compound oral dose. and/or b) the blood AUC _0-24 of the pirfenidone or pyridone analog compound from a dose administered directly to the lungs of the mammal is greater than or equal to oral administration of the pirfenidone or pyridone analog compound Blood AUC _0-24 or less for up to 801 mg of volume. In some embodiments, a) the lung tissue Cmax of the pirfenidone or pyridone analog compound from a dose administered directly to the lungs of a mammal is less than the lung tissue Cmax of an oral pirfenidone or pyridone analog compound dose of up to 801 mg and b) the blood AUC _0-24 of the pirfenidone or pyridone analog compound from a dose administered directly to the lungs of the mammal is greater than or equal to the pirfenidone or pyridone analog compound oral dose of 801 mg blood AUC _0-24 or less. In some embodiments, a) the lung tissue Cmax of the pirfenidone or pyridone analog compound from a dose administered directly to the lung of the mammal is at least up to 801 mg of the pirfenidone or pyridone analog compound oral dose. or b) the blood AUC _0-24 of the pirfenidone or pyridone analog compound from a dose administered directly to the lungs of the mammal is greater than or equal to the oral dose of the pirfenidone or pyridone analog compound Blood AUC _0-24 or less up to 801 mg. In some embodiments, the dose comprises an aqueous solution of a pirfenidone or pyridone analog compound. In some embodiments, the dose is administered with a liquid nebulizer. In some embodiments, the pirfenidone or pyridone analog compound is administered more than once a week. In some embodiments, a single dose of the pirfenidone or pyridone analog compound is administered more than once a week, more than twice a week, more than three times a week, more than four times a week, Administered more than 5 times, more than 6 times a week, or daily. In some embodiments, the pirfenidone or pyridone analog compound is administered on a continuous daily dosing schedule. In some embodiments, the pirfenidone or pyridone analog compound is administered once daily, twice daily, or three times daily.

<Method of administration and treatment regimen>
In one embodiment, the pirfenidone or pyridone analog compound is administered daily to a human in need of treatment with a pirfenidone or pyridone analog compound. In some embodiments, the pirfenidone or pyridone analog compound is administered to humans by inhalation. In some embodiments, the pirfenidone or pyridone analog compound is administered once daily. In some embodiments, the pirfenidone or pyridone analog compound is administered twice daily. In some embodiments, the pirfenidone or pyridone analog compound is administered three times daily. In some embodiments, the pirfenidone or pyridone analog compound is administered every other day. In some embodiments, the pirfenidone or pyridone analog compound is administered twice weekly.

In general, doses of pirfenidone or pyridone analog compounds used for the treatment of the diseases or conditions described herein in humans are typically from about 0.001 mg to about 10 mg per dose. Pirfenidone/kg body weight range. In one embodiment, the desired dose is administered in a single dose, or in divided doses administered simultaneously (or over a short period of time), or at appropriate intervals (e.g., twice, three, four times, daily). or higher subdosages) are conveniently provided. In some embodiments, the pirfenidone or pyridone analog compound is conveniently provided in divided doses administered simultaneously (or over a short period of time) once daily. In some embodiments, the pirfenidone or pyridone analog compound is conveniently provided in divided doses administered in equal amounts twice daily.

In some embodiments, the pirfenidone or pyridone analog compound is administered daily to humans by inhalation. In some embodiments, the pirfenidone or pyridone analog compound is administered orally to humans at a dose of about 0.001 mg to about 10 mg pirfenidone/kg body weight per dose. In some embodiments, the pirfenidone or pyridone analog compound is administered to humans by inhalation on a continuous daily dosing schedule.

The term "continuous dosing schedule" refers to administration of a particular therapeutic agent at evenly spaced intervals. In some embodiments, a continuous dosing schedule refers to administration of a particular therapeutic agent at regular intervals without any washout period from the particular therapeutic agent. In some other embodiments, a continuous dosing schedule refers to administration of a particular therapeutic agent in cycles. In some other embodiments, a continuous dosing schedule includes drug administration after a washout period (e.g., washout period, or other such period during which no drug is administered) from a particular therapeutic agent. refers to the administration of a particular therapeutic agent in cycles of For example, in some embodiments, the therapeutic agent is administered once daily, twice daily, three times daily, once weekly, twice weekly, three times weekly, four times weekly, 5, 6 times a week, 7 times a week, every other week, every 3 days, every 4 days, daily for a week after 1 week of no treatment, 2 after 1 or 2 weeks of no treatment daily for a week, daily for 1, 2, or 3 weeks followed by no treatment, daily for 3 weeks, daily for 1, 2, 3, or 4 weeks, followed by daily for 4 weeks, and treatment for 1 week. Weekly doses of treatment after no treatment, bi-weekly doses of treatment after 2 weeks of no treatment. In some embodiments, daily administration is once daily. In some embodiments, daily administration is twice daily. In some embodiments, daily dosing is three times daily. In some embodiments, daily administration is more than three times daily.

The term "continuous daily dosing schedule" refers to administration of a particular therapeutic agent each day at about the same time each day. In some embodiments, daily administration is once daily. In some embodiments, daily administration is twice daily. In some embodiments, daily dosing is three times daily. In some embodiments, daily administration is more than three times daily.

In some embodiments, the amount of the pirfenidone or pyridone analog compound is administered once daily. In some other embodiments, the amount of pirfenidone or pyridone analog compound is administered twice daily. In some other embodiments, the amount of the pirfenidone or pyridone analog compound is administered three times daily.

In certain embodiments, where no improvement in the human disease or disease state is observed, the daily dose of the pirfenidone or pyridone analog compound is increased. In some embodiments, the once daily dosing schedule is changed to a twice daily dosing schedule. In some embodiments, a three times daily dosing schedule is utilized to increase the amount of pirfenidone or pyridone analog compound administered. In some embodiments, the frequency of administration by inhalation is increased to provide more regularly repeated high Cmax levels. In some embodiments, the frequency of administration by inhalation is increased to provide sustained or more regular exposure to pirfenidone. In some embodiments, the frequency of administration by inhalation is increased to provide more regularly repeated high Cmax levels and to provide sustained or more regular exposure to pirfenidone.

In some embodiments, the amount of repeated high Cmax dosing that provides a more regular exposure of the active therapeutic agent given to the person is, but is not limited to, the state and severity of the disease or illness, human subjectivity. It will vary depending on (eg weight) and the particular additional therapeutic agent administered (if applicable).

<Example>
<Example 1: Pirfenidone formulation>
Non-limiting examples of pirfenidone compositions include those listed in Tables 1-1 through 1-11.

In some embodiments, pirfenidone exhibited an aqueous solubility of up to 17 mg/mL over a pH range of about 4.0 to about 8.0. However, it has been determined that at this (and lower) concentration, salt addition is required to improve acute tolerance upon inhalation of nebulized (otherwise hypotonic) solutions. rice field. NaCl or MgCl ₂ was added to treat osmotic pressure. In some embodiments, the addition of NaCl improved acute tolerance but destabilized the formulation, resulting in a precipitation reaction upon ambient storage. In some embodiments, addition of MgCl ₂ was determined to maintain a stable, soluble solution at this concentration with an osmolality within an acceptable range. By way of non-limiting example, when pirfenidone is 15 mg/mL (or 81 mM), 81 mM MgCl ₂ provides a 1:1 molar ratio of magnesium to pirfenidone. This effect was also observed at various concentrations of pirfenidone, with molar ratios of magnesium to pirfenidone of 1:1 and 1:2, but less than or equal to 0.25:1, or 1:0.33 of magnesium to pirfenidone. None of the above ratios were observed. This effect was observed in 5 mM to 50 mM citrate buffers at pH 4.0 and pH 5.8, and 5 mM to 50 mM phosphate buffers at pH 6.2, pH 7.3, and pH 7.8. . Other observations included: 1) both buffer-based formulations exhibited metallic, bitter and throat irritation; 2) sodium saccharin from 0.1 to 0.7 mM 3) 0.6 mM sodium saccharin was the best concentration, flavoring a 2:1 molar ratio of pirfenidone to magnesium in phosphate buffer and adding a flavor of 1:1 molar ratio of pirfenidone to magnesium in phosphate buffer; 4) a 2:1 molar ratio of pirfenidone to magnesium in citrate buffer without sodium saccharin tasted better than that of pirfenidone to magnesium in phosphate buffer containing 0.6 mM sodium saccharin; 5) a 2:1 molar ratio of pirfenidone to magnesium in citrate buffer containing 0.2 mM sodium saccharin was equivalent to a 1:1 molar ratio of pirfenidone to magnesium in citrate buffer containing 0.6 mM sodium saccharin; was equivalent to a 2:1 molar ratio of pirfenidone to magnesium in acid buffer; 6) a 1:1 molar ratio of pirfenidone to magnesium in citrate buffer containing 0.6 mM sodium saccharin tasted 7) and a 2:1 molar ratio of pirfenidone to magnesium in either buffer system up to pH 6; A 1:1 molar ratio of pirfenidone to magnesium dissolved within 40% of the time required to dissolve the molar ratio. This effect was not observed up to pH 8.

Example 2: Development study of the effects of buffers and pH
The solubility of pirfenidone in citrate and phosphate buffers was investigated (Table 2). Pirfenidone (250 mg) was reconstituted with 5 mL of buffer in water or water alone and mixed thoroughly by sonication and vortexing. The samples were stirred overnight at room temperature. Samples were visually inspected, their appearance noted, centrifuged to sediment any undissolved material, and the supernatant passed through a 0.22 μm PVDF filter and removed via syringe. Filtered samples were tested for: appearance, pH (USP <791>), osmolality (USP <785>), and pirfenidone concentration and pirfenidone % purity by RP-HPLC. The remaining filtered sample was divided into 3 equal volumes in glass vials and placed at 25°C/60RH, 40°C/75RH and refrigerated. Samples were covered with aluminum foil to reduce light exposure. After the first night of incubation, the samples were briefly visually inspected for any signs of discoloration or precipitate formation.

Table 2 shows the solubility of pirfenidone observed under the conditions described.

<Example 3: Effect of co-solvent and surfactant>
The solubility of pirfenidone in the presence of added co-solvents (ethanol, propylene glycol, or glycerin) and surfactants (polysorbate 80 or cetylpyridinium bromide) was investigated. The buffer type, strength, and pH of the aqueous vehicle are selected based on the results from the buffer/pH effect study (Example 2). Pirfenidone (375 mg) is reconstituted with 5 mL of each solvent system shown in Table 3.

Each sample was stirred overnight at room temperature. The samples were visually inspected and their appearance recorded. Samples were centrifuged to sediment any undissolved material and the supernatant was passed through a 0.22 μm PVDF filter and removed via syringe. Filtered samples were tested for the following: appearance, pH (USP <791>), osmolality (USP <785>), and pirfenidone concentration and pirfenidone % purity by RP-HPLC. The remaining filtered sample was divided into 3 equal volumes in glass vials and placed at 25°C/60RH, 40°C/75RH and refrigerated. Samples were covered with aluminum foil to reduce light exposure. After the first night of incubation, the samples were briefly visually inspected for any signs of discoloration or precipitation.

Both ethanol (EtOH) and propylene glycol (PG) increase the saturation solubility of pirfenidone. Both ethanol and propylene glycol have an additive effect in increasing the saturated solubility of pirfenidone.

Selected formulations were subjected to taste testing and osmolality determination and nebulization for throat irritation and/or cough response. Table 4 shows these results.

The results from Table 4 show that co-solvent containing formulations contain relatively high osmolality. Surprisingly, these high osmolality solutions do not exhibit poor inhalation tolerance. A solution containing up to 8% (v/v) ethanol and 16% (v/v) propylene glycol has a sweet taste with minimal bitter aftertaste, minimal throat irritation, and minimal coughing response. have a stimulus. Formulations lacking co-solvents are limited to about 15 mg/mL. These same formulations exhibited a bitter, slightly metallic taste. Surprisingly, high concentrations of pirfenidone formulations (up to 44 mg/mL, by non-limiting example) that allow co-solvents do not exhibit these poor taste characteristics.

The saturated pirfenidone formulation appeared stable for up to 2-5 days under the test conditions. However, in all cases, pirfenidone eventually recrystallized. This recrystallization was not inhibited by prefiltration of the samples. From this observation, concentrations of pirfenidone below saturation were investigated. A concentration of 85% saturated pirfenidone was exposed to several temperatures. These results are shown in Table 5.

The results from Table 5 show that these 85% saturated formulations of pirfenidone do not recrystallize up to 4° C. (at least following overnight incubation). These results suggest that these formulations survived cyclic exposure up to 4° C. and would redissolve without agitation, even if frozen.

Additional studies tested the stability of pirfenidone in 5 mM sodium phosphate buffer, pH 6.5, as a function of co-solvent strength, which was optimized for stability assessment. The target concentration represents the approximately 85% saturation concentration possible with each specified cosolvent concentration. Two additional formulations were tested for stability of pirfenidone at 1 mg/mL in a particular formulation. Pirfenidone (amounts outlined in Table 6) was reconstituted in 100 mL vehicle as described and mixed thoroughly by agitation. The sample was stirred until completely dissolved. Once dissolved, the samples were filtered via syringe through a 0.22 μm PVDF filter.

The samples were cooled to reduce evaporation loss of the volatile co-solvent (ethanol) during filtration and dispersion. Approximately 5.0-mL aliquots of each formulation were transferred to high grade (class A) glass 6 ml containers with appropriate closures (20 mm stoppers). At least 8 vessels are maintained in an upright orientation at 25°C/60RH and another 8 vessels are maintained at 40°C/75RH. One container of each formulation was used for the initial evaluation, t=0, with the following tested: for appearance, pH, osmolality, pirfenidone assay (reported as % labeling). HPLC = RP-HPLC and individual impurities (reported as % pirfenidone and RRT). The stable time point study will assess appearance and pirfenidone assay (reported as % labeling) and individual impurities (reported as % pirfenidone and RRT).

For each different formulation, samples are tested according to the schedule shown in Table 7.

Selected formulations were prepared for pharmacokinetic analysis following aerosol delivery to the lungs of rats. In these studies, lung, heart, kidney, and plasma tissue samples were analyzed for pirfenidone and metabolite content (Tables 16-19). The formulations prepared for this study are outlined in Table 9. Briefly, this study prepared pirfenidone in 5 mM sodium phosphate buffer, pH 6.5, as a function of optimized co-solvent strength. The target concentration for each formulation is 12.5 mg/mL. Pirfenidone (amount as described in Table 9) was reconstituted with 30 mL of vehicle as described and mixed thoroughly by agitation. The samples were stirred until completely dissolved. Once the pirfenidone was completely dissolved, the formulation was filtered through a 0.22 μm PVDF filter via syringe. Filtered samples were analyzed by HPLC.

The samples were then cooled to reduce evaporation loss of the volatile co-solvent (ethanol) during filtration and dispersion. The formulation was transferred to a class A glass container (approximately 10 mL) with a suitable closure (20 mm stopper).

<Example 4: Performance of nebulization device>
Selected formulations are prepared for aerosol characterization of nebulization devices. Briefly, this study prepared pirfenidone in 5 mM sodium phosphate buffer, pH 6.5 as a function of optimized co-solvent strength. These formulations are outlined in Table 10. Pirfenidone (amount as listed in Table 10) was reconstituted as described and mixed thoroughly by agitation. Each sample was stirred until completely dissolved. Once completely dissolved, the formulation was filtered through a 0.45 μm PVDF filter via syringe. Filtered samples were analyzed by HPLC.

Each sample was cooled to reduce evaporation loss of the volatile co-solvent (ethanol) during filtration and dispersion. Each formulation was transferred to a class A glass container with an appropriate closure, as described in Table 10.

<Philips I-neb (registered trademark) AAD system>
For aerosol analysis, three units of each I-neb breath-driven nebulizer were tested in triplicate for each device/formulation combination. Particle size and distribution were characterized using a Malvern Mastersizer aerosol particle sizer. Parameters reported are mass median diameter (MMD), span, fine particle fraction (FPF = % ≤ 5 microns), output rate (mg formulation per second), volume nebulized, volume delivered (in the range of FPF volume of pirfenidone delivered), respirable delivered dose (mg volume of pirfenidone delivered). Aerosol output was measured using a 5 second inhale, 2 second exhale breathing pattern with a ventilation volume of 1.25 L. The results are shown in Table 11.

<PARI eFlow (registered trademark)-35 head>
For aerosol analysis, three units of each e-Flow nebulizer containing 35-heads were tested in duplicate for each device/formulation combination. Particle size and distribution were characterized using an Insitec Spraytec Laser Particle counter. Parameters reported are volumetric median diameter (VMD), geometric standard deviation (GSD), time to nebulize the dose (duration), dose remaining after nebulization (dead volume), and granules minutes (FPF=%≦5 microns). 4 mL of each formulation was tested. The results are shown in Table 12.

<Aerogen Aeroneb (registered trademark) Solo>
For aerosol analysis, between 2 and 4 units of each Aeroneb® Solo nebulizer with an Aeroneb® Pro-X controller were tested with each formulation. Particle size and distribution were characterized using a Malvern Spraytech aerosol particle counter. Parameters reported are volumetric median diameter (VMD), geometric standard deviation (GSD), time to nebulize the dose (duration), dose remaining after nebulization (dead volume), and granules minutes (FPF=%≦5 microns). 1 mL of each formulation was tested. The results are shown in Table 13.

<Example 5: Advanced research on treatment temperature>
This study examined the above ambient temperature stability of pirfenidone in aqueous solution to better understand its stability at this temperature and saturation solubility. This information may be utilized in manufacturing process embodiments of the present invention wherein pirfenidone is dissolved in water at elevated temperatures in the presence or after the addition of co-solvents and/or surfactants and/or cations, and subsequent cooling to ambient temperature provides a higher saturation solubility of pirfenidone than ambient temperature dissolution alone. In this process, the added co-solvents and/or surfactants and/or cations stabilize the dissolved pirfenidone at elevated temperatures during the cooling process, providing a stable, highly concentrated, ambient temperature solution for long-term storage. can provide a formulation of Alternatively, added co-solvents and/or surfactants and/or cations may provide greater access to soluble pirfenidone to maintain in solution than ambient temperature solubility alone. Alternatively, high temperature dissolution may be integrated into manufacturing process embodiments to reduce dissolution time and/or increase lot-to-lot crystalline structure, intangible content, and polymorphic variability to dissolution time and degree of dissolution. can reduce the effect.

Formulations were prepared as described in Table 11. Briefly, this study prepared 250 mg of pirfenidone in 5 mM sodium phosphate buffer, pH 6.5, in the presence of ethanol, propylene glycol, and/or polysorbate 80. The final volume of each formulation was 5 mL. Pirfenidone (amount as listed in Table 11) was reconstituted as described and thoroughly mixed by agitation. Each sample was thoroughly mixed and stirred overnight at 60°C. Rapid and stepwise cooling from 60°C to 25°C was performed. HPLC analysis was performed on samples obtained after overnight incubation and after cooling to 25°C. Formulations were filtered via syringe through a 0.45 μm PVDF filter prior to HPLC analysis. The results for this evaluation are shown in Table 14.

The results in Table 14 show that heating pirfenidone to 60° C. allows sufficient dissolution up to, or potentially more than, 50 mg/mL. Rapid cooling of this melted material to 25° C. led to rapid recrystallization (data not shown). Slow cooling to 25° C. (stepwise from 60° C. to 40° C. to 30° C. to 25° C. with temperature equilibration occurring in each process before further temperature reduction) allowed pirfenidone to It is allowed to remain in solution at approximately 50 mg/mL for several hours before finally recrystallizing. Filtration of each formulation prior to recrystallization (either at 30°C or after equilibration at 25°C) did not significantly extend or prevent recrystallization. The dissolution time of pirfenidone is reduced by heating and appears to be stable at this temperature during the dissolution process. Therefore, heating the pirfenidone formulation may be beneficial in embodiments of the manufacturing process and may overcome the slower dissolution observed at ambient temperature.

<Example 6: Pharmacokinetics and pulmonary tissue distribution>
Sprague-Dawley rats (300-350 grams) were administered pirfenidone by either the oral (gavage) or aerosol (Penn Century MicroSprayer® nebulizing catheter in the trachea) route. For oral administration, 50 mg of pirfenidone was dissolved in 3.33 mL of distilled water containing 0.5% CMC to a final concentration of 15 mg/mL. The solution was vortexed until all crystals dissolved. Rats were dosed with 70 mg/kg pirfenidone (up to 1.4 mL). Plasma samples were taken pre-dose and at 0.08, 0.16, 0.25, 0.5, 0.75, 1.0, 1.5 hours post-dose. after 2, 4 and 6 hours. For lung tissue samples, 8 additional rats were also administered 70 mg/kg by oral route. Lungs were obtained pre-dose and at 0.08, 0.5, 2 and 4 hours after dosing. Material was extracted and pirfenidone was quantified as μg/mL plasma and μg/gram lung tissue. For aerosol administration, 60 mg of pirfenidone was dissolved in 10 mM phosphate buffer, pH 6.2, containing 81 mM MgCl2 ( ₁ :1 pirfenidone to magnesium). Rats were administered 5 mg/kg pirfenidone (up to 100 μL) by nebulization catheter. Plasma samples were taken pre-dose and at 0.08, 0.16, 0.25, 0.5, 0.75, 1.0, 1.5 hours post-dose. After 2 hours, 4 hours and 6 hours. For lung tissue samples, 8 additional rats were also dosed at 70 mg/kg by the oral route. Lungs were obtained pre-dose and at 0.08, 0.5, 2 and 4 hours after dosing. Material was extracted and pirfenidone was quantified as μg/mL plasma and μg/gram lung tissue. Results from these studies are shown in Table 15.

Example 7: Pharmacokinetics and Tissue Distribution of Co-Solvent Formulations
To evaluate the pharmacokinetics and tissue distribution of the co-solvent formulations (described in Table 9), triplicate Sprague-Dawley rats (350-400 grams) were injected with a bolus aerosol (the Penn Century MicroSprayer in the trachea). Pirfenidone was administered via a ® nebulization catheter). Rats were dosed with approximately 4 mg/kg (up to 150 μL) of pirfenidone via nebulization catheter. Plasma samples, and whole lung, heart and kidney were collected pre-dose and at 0.033, 0.067, 0.1, 0.167, 0.333, 0.033, 0.167, 0.333, 0.033 hours post-dose. Obtained after 667, 1.0, 1.5, 2 and 2.5 hours. Material was extracted and quantified as μg/mL plasma and μg/gram lung, heart, or kidney tissue. Results from these studies are shown in Tables 16-19. No adverse events were noted in these studies.

Results from studies of the effect of co-solvents on tissue distribution showed that the presence of up to 8% ethanol with 16% propylene glycol reduced tissue or plasma drug concentration compared to 0.4% sodium chloride formulations. It is shown to change kinetic properties. Furthermore, these results indicate a delayed appearance of 5-carboxy-pirfenidone, the major hepatic metabolite of pirfenidone. A comparison of the initial rapid elimination of pirfenidone from lung tissue and the parallel appearance of pirfenidone in plasma suggests that direct pulmonary administration may be an excellent route for systemic administration of pirfenidone. do. The delayed appearance of a metabolite of 5-carboxy-pirfenidone has led to the hypothesis that this metabolite serves as a marker for recycling of pirfenidone to the lung and other tissues after direct aerosol administration to the lung. To support. Furthermore, as suggested in Tables 15 and 16 and supported by the data modeled in Figure 1 and Table 20, recycled pirfenidone has long-term effects in the lung and other tissues of potential efficacy. Likely to contribute to pirfenidone levels.

To understand the human pulmonary tissue distribution and associated pharmacokinetics of pirfenidone after 10-12 minutes of nebulized administration from the nebulizer, measured rat pharmacokinetics and Lung tissue distribution data were quantified. Briefly, rat aerosol pulmonary data and plasma delivery were scaled to humans using relative growth rates. Rat data were obtained from Tables 16 and 17. The relative growth rate is according to US FDA Guidance for Industry-Estimating the Maximum Safe Starting Dose in Initial Clinical Trials for Therapeutics in Adult Healthy Volunteers. July, 2005, and Caldwell et al. , European Journal of Drug Metabolism and Pharmacokinetics, 2004, Vol. 29, No. 2, pp. 133-143 were used. For comparison, human plasma pharmacokinetic data resulting from oral administration were obtained from Rubino et al. , 2009 directly. For oral data, fed human data were used. Pharmacokinetic data from fasted humans were used to model the pharmacokinetics of plasma pirfenidone when it is delivered from an aerosol dose (Rubino et al., 2009). Inhaled aerosol-derived plasma pirfenidone levels were calculated based on an assumed 100% bioavailability of inhaled, respirable deposited pirfenidone per 5,000 mL total blood volume. Calculated. The contribution of plasma-derived pirfenidone (either from oral or aerosol inhalation administration) to pulmonary tissue distribution and pharmacokinetics was assumed at any given time at which 50% of plasma pirfenidone was delivered to lung tissue. By way of example, a plasma level of 10 μg/mL contributed 5 μg/gram of pirfenidone to lung tissue. The results of this analysis are shown in FIG. 1 and Table 20.

Aerosol delivery parameters were based on the properties of the formulations in Table 10 in a high-efficiency, mesh-based nebulizer. Respirable delivered dose (RDD) was calculated by fine particle fraction (FPF, %<5 microns) and inhaled mass of product. An RDD of approximately 110 mg was calculated from a 5 mL device loaded dose of a 40 mg/mL pirfenidone formulation (200 mg loaded dose). The FPF and inhaled mass were 85% and 67%, respectively. Inspired mass was calculated based on breathing patterns. A 1:1 inspiratory:expiratory breathing pattern (eg, 2 seconds exhalation followed by 2 seconds inhalation) using an eFlow device and a 35 head is expected to produce approximately 67% inspired mass. From this, a 2:1 breathing pattern (eg, 2 seconds of exhalation followed by 4 seconds of inspiration) may produce between about 74% and about 80% of the inspired mass. Using an inspired mass of 74% and an FPF of 85%, a device-filled dose of 200 mg can produce an RDD of approximately 125 mg. Similarly, an 80% inhaled mass can produce an RDD of approximately 136 mg from a device-loading dose of 200 mg. Continuing, a 3:1 breathing pattern (eg, 2 seconds of exhalation followed by 6 seconds of inspiration) can produce between about 80% and about 87% of the inspired mass. Using an inspired mass of 87% and an FPF of 85%, a device-filled dose of 200 mg can produce an RDD of approximately 148 mg. In some embodiments, the RDD is further increased or decreased by additional means: by non-limiting examples, changing the volume with which the device is filled and/or changing the pirfenidone concentration of the formulation. obtain. In some embodiments, increasing the formulation concentration to 50 mg/mL and using a 5 mL device fill volume will provide a 250 mg device fill dose. Using an FPF of 85% and an inhaled mass of approximately 67%, a device-loading dose of 250 mg can produce an RDD of approximately 142 mg, and an inhaled mass of 74% produces an RDD of approximately 157 mg. An inhaled mass of 80% could produce an RDD of approximately 170 mg, and an inhaled mass of 87% could produce an RDD of approximately 185 mg. Additional dose escalation is possible with the addition of increased co-solvents to the pirfenidone formulation. Similarly, dose escalation is possible with reduced device-filled dose (reduced volume and/or reduced concentration of pirfenidone formulation) and/or less efficient breathing patterns. While relative growth rate is an established tool for predicting pharmacokinetic parameters and dosage scaling between animals and humans, it remains in the lungs for substantially longer than predicted by relative growth rate. Precedent exists in favor of inhaled therapies in humans. This possibility also results in a longer residence time of pirfenidone in the lungs, which can translate into reduced plasma exposure.

Example 8: Pharmacokinetics and tissue distribution of co-solvent formulations
Previous intratracheal aerosol delivery (see Example 6) was performed as a single bolus instillation just above the first branch of the lung. For in vivo efficacy studies, an attempt was made to mimic ventilation inhalation respiration by dividing the dose into equal aliquots and administering as before, but over 2 minutes. For this task, four groups of Wistar rats (300-500 grams) were given a total of 300 mcL per animal divided into six equal doses of 50 mcL per animal for a total of 2 minutes. pirfenidone by bolus aerosol (intratracheal Penn Century MicroSprayer® nebulization catheter) or by bolus oral gavage (300 mcL/animal). dosed.
Doses were prepared in 0.45% sodium chloride solution and administered as described in Table 21.

Plasma samples and whole lungs were collected pre-dose, 2, 4, 6, 10, 30, 60, and 120 minutes post-dose. Material was extracted and quantified with pirfenidone as mcg/mL plasma and μg/gram lung tissue. The results of these studies are shown in Table 22. There were no notable adverse events in these studies.

Example 9: In Vivo Efficacy - Bleomycin Model of Pulmonary Fibrosis
To compare the antifibrotic efficacy between prolonged intratracheal direct pulmonary aerosol administration and oral gavage, a bleomycin model of pulmonary fibrosis was performed. The doses for this study were selected based on the pharmacokinetic parameters obtained in Table 22 (from Example 8). Briefly, Wistar rats (175-225 grams) were administered bleomycin by the intratracheal route using a Penn Century MicroSprayer® catheter. Seven days after bleomycin exposure, animals began treatment with saline or pirfenidone. Animals were dosed once daily from days 7 to 28 and were euthanized on day 29. Pirfenidone was administered intratracheally using a Penn Century MicroSprayer® catheter or by oral gavage. Sham and bleomycin control groups received no treatment or received saline intratracheally via a Penn Century MicroSprayer® catheter. While more frequent (or less frequent) dosing may improve the observed effects, the anesthesia required for intratracheal administration reduces animal weight gain (food intake). dose was reduced), therefore dosing was limited to once daily in this study. All study animals (intratracheal, oral, or control) received isoflurane once daily using the same technique and duration, as anesthesia reduced weight gain. Twelve animals were enrolled in each treatment group. For oral pirfenidone, one group received 30 mg/kg by oral gavage and the second group received 100 mg/kg. For intratracheal pirfenidone administration, one group was at 0.9 mg/kg (targeted to match an oral lung tissue Cmax of 30 mg/kg), the second at 3.0 mg/kg. (targeted to match an oral lung tissue Cmax of 100 mg/kg) and a third group received 6.4 mg/kg (targeted to match an oral plasma AUC of 30 mg/kg). received). Oral gavage was administered in a single volume of 300 mcL. Due to technical limitations, instead of dividing the mg/kg dose equally into six 50 mcL doses over 2 minutes, three equivalent 50 mcL doses were administered every 40 seconds over the same period of time for intratracheal administration. did Dose selection was extrapolated from the data in Table 22. Animals were euthanized on day 29. The right lung was extracted and hydroxyproline content was measured, and the left lung was subjected to histological examination. Histological sections were stained with picrosirius red and scored for lung tissue fibrosis. Twenty random photographs of each stained lung tissue section were taken, blinded and scored by an independent viewing panel. The observations were repeated and analyzed. The data and results of these studies are presented in Tables 23, 24, 25, 26, and 27 and Figures 3 and 4.

The doses selected for this study targeted critical pharmacokinetic parameters from the comparator oral route (matching lung tissue Cmax or plasma AUC). These targets were selected from pharmacokinetic studies, lung tissue and plasma were collected, and pirfenidone levels were compared. In these studies, lung tissue Cmax after intratracheal administration was always at the time of initial collection. It is important to consider that the time required to obtain this initial lung tissue may not accurately capture the true lung Cmax. In our study, the acquisition time was approximately 1 minute. It was this pharmacokinetic point that the above Cmax of dosing was chosen. Cmax may be higher if lung tissue can be harvested earlier. The Cmax that can be achieved in these studies may be higher as the Penn Century MicroSprayer® catheter delivers nearly the full loading dose. As an example, a 250 gram rat lung weighs approximately 1.5 grams. By delivering a dose of 0.9 mg/kg (225 mg) to this animal, a lung tissue Cmax of up to 150 mcg/gram is obtained. In this study, the dose was divided into thirds. Therefore, the possible Cmax was approximately 50 mcg/gram of lung tissue (approximately five times that actually achieved by an oral dose of 30 mg/kg). Contrary to the interpretation that large systemic pirfenidone exposures reduce pulmonary efficacy, oral doses of approximately 150-200 mg/kg are doses that the oral safety profile does not allow, 50 mcg/gram pulmonary Required to achieve tissue Cmax.

From these results and other nonclinical and clinical experience with pirfenidone, lung Cmax appears to be important for antifibrotic efficacy. Furthermore, while Cmax is important, high systemic exposure attenuates this effect. Oral dosing produces a very large plasma AUC, but only a small lung tissue Cmax. By comparison, high lung tissue C values for low systemic exposure can be achieved by delivering relatively small aerosols directly to the lungs to achieve low lung tissue doses (oral delivery does not). dosing profile that is not).

The results of this study show that pirfenidone is more effective (less fibrosis and less hydroxyproline) when delivered directly to the lung. However, high-dose systemic pirfenidone exposure directly or indirectly attenuates this effect. Specifically, the oral route requires large oral doses to achieve relatively small lung tissue Cmax. Achieving similar Cmax without large systemic doses enhances efficacy. However, escalating this direct pulmonary dose results in increased systemic exposure and reduces this effect. We compared these results to other published reports (Swaney et al. Br. J. Pharmacol. 160(7):1699-713, 2010; Tian et al., Chin. Med. Sci. J. 21(3): 145-51, 2006; and Trivedi et al., Nanotechnology. 23(50):505101, 2012), it is clear that pirfenidone follows an AUC-dependent U-shaped dose response. Specifically, a high lung tissue Cmax is important for the anti-fibrotic efficacy of lung tissue. However, this positive effect It appears to be dependent on a small relevant plasma AUC, the higher the plasma AUC, the lower the efficacy. Figures 3 and 4 show the AUC-dependent U-shaped pirfenidone dose response. In practice, the oral route of administration cannot meet this U-shaped limited dose response. Safety and tolerability prevent further dose escalation of the 801 mg oral drug (Esbriet®) per dose. These data and other published studies (Swaney et al., 2010, Tian et al., 2006, and Trivedi et al., 2012) suggest that plasma AUC may be associated with increased oral dosing. An increase in Cmax may reduce or negate any relevant lung tissue Cmax benefit. By comparison, inhalation of small aerosol pirfenidone doses allows dosing within a U-shaped dose response: high lung tissue Cmax, low plasma AUC. To illustrate this finding, the possible human lung tissue and plasma pharmacokinetics after aerosol administration via ventilation-breathing-inhalation were again modeled (Fig. 5). As noted, safety and tolerability limit further increases in the 801 mg oral pirfenidone dose (801 mg taken thrice daily). These safety and/or tolerance limitations may be associated with plasma AUC, plasma Cmax, gastrointestinal exposure, or a combination of these events. For modeling purposes, the plasma AUC from an oral pirfenidone dose of 801 mg was established as the limit for inhaled aerosol pirfenidone administration. However, this limit can also be set as plasma Cmax, or a combination of these pharmacokinetic parameters.

The aerosol delivery parameters for the models of Figures 2 and 5 were based on the characteristics of a highly efficient, mesh-based nebulizer (Table 12). Pulmonary half-life after aerosol delivery was determined from both bolus intratracheal (Examples 6 and 7) and chronic intratracheal (Example 8) pharmacokinetic results of pirfenidone. The respirable delivered dose (RDD) was calculated by product and inhaled mass of the fine particle fraction (FPF, %<5 microns). Using the pulmonary half-life from the bolus intratracheal pharmacokinetic results, modeled human pharmacokinetics after ventilated inhalation of 47 mg RDD for approximately 5 minutes compared to the 25 mg/mL pirfenidone formulation (90 mg load). Dose) was calculated from the 3.6 mL device loading dose. For this non-limiting example, an FPF of 78% and an inspired mass of 67% were used. Using these numbers, a device loading dose of 90 mg may result in an RDD of approximately 47 mg (Table 26 and Figure 2). The lung half-lives obtained from the long-term intratracheal pharmacokinetic results were used to recalculate the modeled human pharmacokinetics after ventilated inhalation of 120 mg, 50 mg, and 2.5 mg RDD ( Figure 5). An RDD of approximately 120 mg was calculated from a 3.6 mL device loading dose of the 68 mg/mL pirfenidone formulation (230 mg loading dose). For this non-limiting example, an FPF of 78% and an inspired mass of 67% were used. Using these numbers, a device loading dose of 230 mg may result in an RDD of approximately 120 mg. An RDD of approximately 50 mg was calculated from a 3.6 mL device loading dose of the 27 mg/mL pirfenidone formulation (96 mg loading dose). Similarly, a 2.5 mg RDD was calculated from a 0.66 mL device loading dose of the 7.2 mg/mL pirfenidone formulation (4.8 mg loading dose). This latter dose was modeled to be delivered in 1 minute. Dosage increases are possible by adding increased amounts of co-solvents to the pirfenidone formulation. Similarly, dose reduction is possible due to reduced device load dose (decreased volume and/or decreased pirfenidone formulation concentration) and/or inefficient breathing patterns. Reduction of pirfenidone formulation concentrations below about 20 mg/mL may not require co-solvents, but may include buffers, permeant ions, tonicity modifiers, or taste-masking agents. . Pulmonary excretion and plasma exposure assume 100% bioavailability after inhalation aerosol administration. Therefore, actual human plasma pirfenidone exposure may be reduced after inhaled human administration.

A further clinical consideration is the rat plasma AUC that showed no efficacy in the bleomycin model. By way of non-limiting example, as shown in FIGS. 3 and 4, administration of 3.0 mg/kg intratracheal direct pulmonary aerosol to rats resulted in a plasma AUC of occured. Antifibrotic effects have been shown only at low doses delivered. Plasma AUC obtained from high intratracheal or oral doses appear similarly ineffective or enhanced disease. Therefore, it can be argued that an inhalation-delivered plasma AUC that is less than obtained from an intratracheal dose of 3 mg/kg may be important for permitting efficacy of pirfenidone. Using non-proportional measurements (by total surface area), matching a 3 mg/kg rat dose to a 60 kg human resulted in a delivered pulmonary dose for a 29 mg human (equivalent lung clearance rate and 100% (assuming bioavailability of ). From this, a consideration in human dosage may be that an RDD equivalent to an intratracheal aerosol dose of 29 mg may result in a human plasma AUC that represents the upper limit of the U-shaped pirfenidone dose-response curve. unknown.
Potentially achievable human lung tissue Cmax and plasma AUC _{0-18 hrs} after administration of a 3-minute ventilated inhaled nebulized dose resulting in an RDD of 29 mg using a long-term intratracheal pharmacokinetic data model are 43.2 mcg/gram of lung tissue and 13.4 mcg·hr/mL, respectively.

The various embodiments described above can be combined to provide further embodiments. All US patents, US patent application publications, US patent applications, foreign patents, foreign patent applications, and non-patent publications referenced in this specification are hereby incorporated by reference in their entirety. Aspects of the embodiments may be modified, if necessary, to employ concepts of the various patents, applications, and publications to provide yet further embodiments. These and other changes can be made to the embodiments in light of the above detailed description. In general, the terms used in the following claims should not be construed to limit the claims to the particular embodiments disclosed in the specification and claims, although such claims may be entitled to should be construed to include all possible embodiments along with the full scope of equivalence to those provided. Accordingly, the claims are not limited by this disclosure.

Claims (18)

1. An aqueous pharmaceutical composition for use in treating interstitial lung disease formulated for nebulized administration as an aerosol delivered by inhalation into the lungs of an adult from a liquid nebulizer, said aqueous pharmaceutical composition comprising , a pirfenidone or pyridone analog in an aqueous solution at a concentration of 5.0 mg/mL to 18.0 mg/mL with an osmolality that is from about 50 mOsmol/kg to about 2000 mOsmol/kg, wherein the daily dose is 360 mg/kg. An amount of pirfenidone or a pyridone analog not more than a day, which is therapeutically effective for reducing forced vital capacity (FVC) decline in adults suffering from interstitial lung disease;
the respirable delivered dose of said aqueous pharmaceutical composition does not exceed an amount of 29/60 mg/kg body weight given four times a day, or 1.93 mg/kg body weight per day;
The analogs of said pirfenidone or pyridone are 1-phenyl-2-(1H)pyridone, 5-methyl-1-(4-methylphenyl)-2-(1H)-pyridone, 5-methyl-1-(2′- pyridyl)-2-(1H)pyridone, 6-methyl-1-phenyl-3-(1H)pyridone, 6-methyl-1-phenyl-2-(1H)pyridone, 5-methyl-1-p-tolyl- 3-(1H)pyridone, 5-methyl-1-phenyl-3-(1H)pyridone, 5-methyl-1-p-tolyl-2-(1H)pyridone, 5-ethyl-1-phenyl-2-( 1H) An aqueous pharmaceutical composition selected from pyridone, 5-ethyl-1-phenyl-3-(1H)pyridone, and 4-methyl-1-phenyl-3-(1H)pyridone. 2. The aqueous pharmaceutical composition of Claim 1, further comprising a citrate or phosphate buffer. 3. The aqueous pharmaceutical composition according to claim 1 or 2, wherein the interstitial lung disease is idiopathic pulmonary fibrosis. 4. The aqueous pharmaceutical composition of any one of claims 1-3, wherein the total daily dose of pirfenidone or pyridone analogue administered to an adult by liquid nebulizer is less than 360 mg. 2. The aqueous pharmaceutical composition of claim 1, having an osmotic ion concentration of about 0.1% to about 5.0%. 6. The aqueous pharmaceutical composition according to any one of claims 1 to 5, having a pH of pH 5.0 to pH 6.0. 7. The aqueous pharmaceutical composition of any one of claims 1-6, comprising the one or more salts in an amount of about 0.01 to about 2.0 weight percent of the aqueous pharmaceutical composition. 8. The aqueous pharmaceutical composition of Claim 7, wherein the salt is selected from the group consisting of sodium chloride, magnesium chloride, sodium bromide, magnesium bromide, calcium chloride, and calcium bromide, and combinations thereof. 9. The aqueous pharmaceutical composition of any one of claims 1-8, which delivers between 5.0 mg and 25.0 mg of pirfenidone or pyridone analog to the lungs of an adult human. Interferon gamma, interferon beta-1a, pentraxin-2, N-acetyl-L-cysteine, GS-6624, IW001, PRM-151, STX-100, CC-930, QAX576, FG-3019, CNTO-888, BIBF- 1120, antibodies targeting IL-13 ligands or receptors, antibodies targeting integrin alpha-vbeta-6, antibodies targeting CTGF ligands or receptors, antibodies targeting CCL2 ligands or receptors, blood vessels Small molecules targeting endothelial growth factor (VEGF) ligands or receptors, small molecules targeting platelet-derived growth factor (PDGF) ligands or receptors, targeting fibroblast growth factor (FGF) ligands or receptors LOXL2 12, a targeting antibody, a small molecule targeting Jun kinase, and a small molecule targeting TGFbeta, and combinations thereof, for treating interstitial lung disease 10. The aqueous pharmaceutical composition of any one of claims 1-9, further comprising one or more additional therapeutic agents of 2. The aqueous pharmaceutical composition of claim 1, wherein a higher lung tissue Cmax is achieved after administration of a single aerosol dose to an adult than is achieved after administration of an 801 mg oral dosage form of pirfenidone to an adult. 12. The aqueous pharmaceutical composition of claim 11, wherein a lower plasma AUC is achieved after administering a single aerosol dose to an adult human than is achieved after administering an 801 mg oral dosage form of pirfenidone to an adult human. 2. The aqueous pharmaceutical composition of claim 1, wherein the liquid nebulizer comprises
(i) achieving pulmonary deposition of at least 7% of pirfenidone or pyridone analogues administered to an adult;
(ii) providing an aerosol having a geometric standard deviation (GSD) of the emitted droplet diameter distribution of the aqueous solution from about 1.0 to about 2.5;
(iii) producing an aerosol having a median aerodynamic diameter (MMAD) of the droplet diameter of the aerosol from about 1 μm to about 5 μm; providing 30% (FPF=%≦5 μm),
Aqueous pharmaceutical composition. The claim further comprising one or more additional ingredients selected from co-solvents, taste-masking agents, tonicity agents, sweeteners, surfactants, humectants, chelating agents, antioxidants, salts, and combinations thereof. 2. The aqueous pharmaceutical composition according to 1. 2. The aqueous pharmaceutical composition of claim 1, wherein the liquid nebulizer comprises an aerosol generator and a drug chamber in which the aqueous pharmaceutical composition is placed. 16. The aqueous pharmaceutical composition of claim 15, wherein the liquid nebulizer is a jet nebulizer, an ultrasonic nebulizer, a pulsating film nebulizer, a nebulizer comprising a vibrating mesh or plate with multiple openings, or a piston nebulizer. A therapeutically effective dose is placed in a liquid nebulizer comprising an aerosol generator adapted to receive a liquid reservoir containing a metered volume of single or multiple doses, the received liquid reservoir containing a liquid. 2. The aqueous pharmaceutical composition of claim 1, which functions as a drug container within a nebulizer. Total daily dose of pirfenidone or pyridone analogs not exceeding 360 mg/day or the respirable delivered dose rate does not exceed 29 mg/3 min. An aqueous pharmaceutical composition according to any one of claims 1 to 3.

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